Long-Term Adverse Effects and Complications After Treatment

This study is excellent! Thanks for posting!

Besides defining differences in the types and probabilities of encountering various side effects after surgery and radiation treatment, it also defines the advantages of choosing active surveillance for men initially diagnosed with low or favorable intermediate risk PCa.

From the study:

“Conclusions and Relevance: This cohort study found that, even after accounting for age-related symptoms and disease, PCA treatment was associated with higher rates of complications in the 12 years after treatment. Given the uncertain benefit of PCA treatment for most patients, these findings highlight the importance of patient counseling before PCA screening and treatment and provide a rationale for pursuing opportunities for cancer prevention.“

Turns out that (see article below):

“Participants who had been diagnosed with prostate cancer but had not received treatment (because this cancer tends to grow slowly, many men choose active surveillance), along with those who had not been diagnosed with prostate cancer, served as an untreated control group for comparison.”

“The authors argue that given the uncertain benefit of prostate cancer treatment for most patients, these findings highlight the importance of patient counseling before treatment and before screening.”

Finally, a large, long term study that quantifies the benefit of choosing AS over surgical or radiation treatment in cases of low or intermediate risk PCa!
https://www.swog.org/news-events/news/2024/11/07/long-term-risks-prostate-cancer-treatment-detailed-new-report

I do have a problem with this statement in the report

“This study throws down a major gauntlet to all physicians to give patients this information before they even begin the process of drawing a PSA test,”

Since the vast majority of people getting that test won’t have anything to worry about, giving everyone all that information, about drawbacks and risk of treatment ahead of time, is really not going to be at all useful to most men.

Understand how that statement could be interpreted as a pejorative call of repentance towards physicians, when it may have been better aimed at the more nebulous “medical-industrial establishment”.

Even so, the best investment advise must include disclaimer statements.

Richard Ablin, who discovered the prostate-specific antigen (PSA), has expressed concerns about its use in widespread screening for prostate cancer. He argues that the PSA test is unreliable and has been misused, leading to overdiagnosis and overtreatment. Ablin believes that the test should not be used as a general screening tool for all men, as it can result in unnecessary treatments and complications without significantly improving outcomes.

IMHO PSA screening may have been “better than nothing” in years gone by; however, there are now much more specific and reliable non-invasive tests that could be used for PCa screening, which would be just as cost effective if scaled to screening volumes.

Others may know better, but I think ultrasensitive PSA testing is still considered a very effective method for monitoring men after radical prostatectomy, as it provides a significant lead-time advantage in detecting biochemical recurrence…probably a better use of PSA monitoring.

The thing is when somebody has a high PSA they do a biopsy. If the biopsy doesn’t show anything above a Gleeson six then they don’t recommend anything be done right away

If doctors went straight from high PSA to surgery or radiation that would be a different story, but that is not what is happening

Not sure about “somebody”, but in my case when my PSA level came in at 7.8 I was referred to a urologist whose first recommendation was to do a mpMRI.

It was only after the mpMRI found three lesions (PIRADS 3, 4 and 5) that my urologist recommended a targeted fusion biopsy.

That should be standard practice.

If a doctor recommends a biopsy, solely based on an elevated PSA level, it’s time to head for the door and run!