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Active Surveillance- Systematic Review of Interventions
Prostate Cancer | Last Active: 6 hours ago | Replies (35)Comment receiving replies
@handera Man, that study is REALLY bizarre!! So telling men that PSA screening is going to look for ‘precancerous’ conditions - and NOT label their GG1 as ‘cancer’ - is going to increase the number of men seeking screening and thereby avoid an increase in PCa deaths ( by men NOT wanting to be screened in order not to hear the word ‘cancer’); and by a 6 fold decrease in mortality at that?
That’s really reaching, IMO.
Let’s try this: I personally was diagnosed with bladder ‘cancer’ Grade 0, meaning not invasive into the muscle layer.
I had these lesions removed 3 times by two different surgeons and they all came up Grade 0; however, the fact that they kept coming back prompted my urologist to intervene with BCG/Interferon injected into the bladder to attempt to halt the process.
Knock wood, so far it has worked for almost 5 years and I am still alive.
When I questioned my doc about why I needed to worry, since the Grade 0 was the lowest form of cancer possible, he told me these lesions can change all the time and leapfrog from a Grade 0 to a Stage 4 rather quickly; dead in a year once that happens.
Having that word ‘cancer’ burned into my brain prompted me to keep up with my screening every 6 months, find new lesions while small snd treatable, and finally have treatment to hopefully eradicate it for good🤞.
Had I been told it was ‘precancerous’ and should be watched, I, as a health professional, would have continued screening, but How many less educated, less informed men would???
How many would view necessary periodic screening as a nuisance or a money grab by big medicine? I can almost hear, “Yeah, doc, LIFE is a precancerous condition…take care!”
So for me, this study is a real problem and I cannot imagine what AI engine or thought process came up with the conclusion that changing the words changes the facts. You can’t SPIN abnormal cells into something you WISH they were.
We now know so much more about overtreatment, AS, Decipher scores, genomic tests…there’s no need to change the words when all you have to do is change the protocol. Best,
Phil
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@heavyphil
Appreciate your opinion, and understand your example.
However, before you dismiss this as “bizarre” you may not have considered these factors:
Drs. Andrew Vickers, of Memorial Sloan Kettering; Matthew Cooperberg, of UCSF; Christian Pavlovich, of Johns Hopkins; Peter Carroll, of UCSF, and Scott Eggener, UCLA, the authors of this study, are among the most influential and cutting edge physicians in the active surveillance field.
They are about as very far from “anti-treatment whack jobs” as one can get.
However, because of their vast experience with PCa patients they see what attempts to “PSA screen” every man has done within their own specialties…regarding the over treatment of scared, uninformed men.
I can think of only a couple other physicians who are so well known for their work in the active surveillance field.
It’s difficult for you and I to put ourselves back to when we knew little to nothing about the prostate; but these physicians see newbies everyday and there often emotional, even irrational, reactions when trying to come to grips with a “cancer” diagnosis.
Couple that initial ignorance with the fact that most have absolutely no symptoms whatsoever and these men are reluctant to justify any attempt to be “PSA screened” or they easily decide “I’ll think about that later…I feel just fine”.
The fact of the matter is that some of these “clueless” men DO indeed have clinically significant PCa and it should be treated (unfavorable risk and above) but they are in that “ignorance is bliss” state….until they are not.
It’s now well known among these physician experts in AS (whether you want to admit it or not) that true Gleason 3+3 “cancer” does not metastasize. Yes, men with that diagnosis sometimes progress to a more aggressive diagnosis, but that is because smaller, more aggressive tumors were simply missed in the original biopsy diagnosis.
What should one expect when only sampling ~2% of the prostate during a biopsy?
No one is “spinning” anything regarding terminology. These physician experts are clear that 3+3 cells are abnormal…so is HGPIN….
The point is that 3+3 does not metastasize AND that this is the key feature of what we, in our culture, call “cancer”.
Even the unformed equate the word “cancer” with uncontrollable cell growth, leading to death.
I am a researcher of 45 years, so I probably have a different perspective regarding scientific data…both its value and its limitations.
However, most folks I know don’t see it that way…they hear that they have “cancer” and immediately draw conclusions based on folks they know that died of their cancer.
I’ve seen so many comments from men that, because they heard the word “cancer” associated with their disease come to an absolutely irrational conclusion…”just cut it out of me”….not realizing that even if it truly is cancer with metastatic potential, that “cutting it out” is highly likely NOT to solve their problem…note BCR rates.
Anyway this study, now two days old, by the leading physician authorities in the field of AS is going to have a huge impact regarding the diagnosis and care of what today I’m still calling “low risk prostate cancer”.
I can’t wait until the medical profession finally sharpens its pencil and comes up with a phrase that truly captures the meaning of a LR PCa diagnosis.