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Ignoring Prostate Cancer Entirely
Prostate Cancer | Last Active: 2 hours ago | Replies (32)Comment receiving replies
Every time I read this study I really scratch my head. And I’ve read it at least 3X because I thought I was reading it incorrectly.
“PSA detected, localized” is sort of an ideal and I have to assume they’re speaking about low Gleason scores as well. When I think of my own situation (Gleason 4+3), surgery 6 years ago, now followed by radiation with ADT I cannot believe that this disease would NOT have killed me if I just watched it for 15 years, you know? But maybe I’ll die anyway, in spite of treatment😳?
I know I am a pessimist, but even an optimist would have been a little concerned with those stats. My cancer was considered localized as well and post op pathology showed negative margins, and no lymphatic spread.
But We’ve all seen how unpredictable the PSMA scan can be, showing NO metastatic areas in post- op salvage situations of PSA 10 or more; so how can any case be deemed “localized” when you can’t see if it’s outside the gland with any great degree of accuracy? Micrometastases simply don’t show.
Maybe if you are age 75 and over, I could see a 15 yr horizon being reasonable for the decision to treat or not - even with a higher PSA - but can a man in his 60’s really roll the dice on this British study?
I am always wary of an overburdened health care system - or an insurance companies recommendations- for cancer detection and treatment.
A few years back insurance companies said that they would only pay for PAP smears every other year instead of annually because it wasn’t ‘necessary’ to screen yearly…two years is plenty of time for uterine cancer to spread.
I could ramble for days about so many other tests and procedures but you get where I’m going…
It’s a great post, though, because it really shows the state of confusion about this disease even at the highest levels of the medical hierarchy.
Best,
Phil
Replies to "Every time I read this study I really scratch my head. And I’ve read it at..."
Well said! Those newly diagnosed and treated should be given a wecome basket of fruit, granola and a packet of "Depends." Greetings from the "Land of many ?'s and few answers" would be the card. With a background chorus of "What's a PSA test?" "I've never hheard of that" YES the amount if ignorance in the general public about PC and the importance of PSA testing is STILL apalling.
SW
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A few comments:
- IMHO “individual patient circumstances and preferences” ALWAYS trump even the best RCT’s.
- many folks equate “active surveillance” with “doing nothing”; when a true AS program is actually the opposite.
- the fundamental idea of AS is tied to the nature of low risk PCa….if/when the clinical/genomic evidence indicates unfavorable progression has occurred, usually defined by a confirmed biopsy of Gleason 4+3 (or higher) or a high risk Decipher score, THEN it is time to select a definitive treatment.
Of course, some men simply cannot bear the idea of any form of “cancer” being found in their body.
This is why some urologists and researchers advocate for a name change of Gleason 3+3 prostate cancer, suggesting terms like “IDLE” (Indolent Lesion of Epithelial Origin).
- the point of the ProtecT trial was to prove (as well as medical science is capable of proving) that there is no STATISTICALLY significant reason to choose immediate treat over AS for localized PCa.
In others words, one is NOT “rolling the dice” by choosing AS with low risk PCa.
….but low risk PCa folks are going to do what they want to do and and you’ll get no argument from me if it was simply a personal preference….just don’t indicate that “science” is the reason for their POV.