Overtreatment of Prostate Cancer

Posted by craftsmanctfl @craftsmanctfl, Oct 21 8:51am

Urologists are trained to do invasive treatment, such as prostatectomy, for many levels and types of prostate cancer. There may be a tendency to overtreat since treatment is what they’ve learned and likely constitutes the greater part of their prostate cancer practice. I’m 74 and a nodule was found by my urologist through a digital rectal exam (DRE). He set up both a CT scan and MRI (both covered by insurance – Medicare Advantage – in my case). The MRI reading came back suspicious for the nodule and found one other small lesion that was suspicious. I then had a transrectal ultrasound biopsy which showed cancer in two of 14 cores taken. The small one was Gleason 3+3 and the larger one was 3+4. That put me in the staging group of intermediate favorable. My urologist then had my biopsy tissue sent for a genetic/genomic test by , which was also covered by my insurance). It came back indicating I was in the active surveillance (AS) category, although at the high end. My urologist and I agreed to go the AS route with appropriate PSA testing and likely biopsies going forward. If progression is found, I can then opt for appropriate treatment before any metastasis can take place. And newer, more effective treatments may then be available. My point, and it is only that of an informed layperson, is that Gleason cancer scores of 3+4 are not necessarily an indication for treatment. However, the younger you are, the more likely that 3+4 may require treatment. Always review your particular situation with a trusted urologist. But different urologists can have differing viewpoints on treatment, so second opinions are often appropriate. Excellent YouTube videos on many aspects of prostate cancer are by Mark Scholz MD and Michael Ahdoot MD.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

northoftheborder | @northoftheborder | Oct 21 3:05pm

I'm at the other end of the spectrum because my PC wasn't discovered until stage 4, when it had already metastasised to my spine. In the past, the treatment emphasis for stage 4 was always palliative (minimal intervention, manage pain, help quality of life), but recently there's been a push to treat oligometastatic cancers (< 4–5 metastatses) with curative rather than palliative intent. My onco team was already on top of that — thankfully, my city's cancer centre is associated with a research university, and is on top of the latest thinking — but once I understood what was happening, I encouraged it. I requested and received a full curative-intent dose of radiation (SBRT) to my prostate, knowing that it might cause complications, because I'm relatively young (56 at diagnosis; 58 now) and wanted to give myself the best chance possible. In the end, I did experience benign radiation damage to the bottom of my bladder, and it's been a bit of a challenge pain and lifestyle-wise, but my quality of life is good and I have no regrets about going for the max treatment in my particular case. Even if it doesn't work out, my family will know that I left no reasonable stone unturned.

craftsmanctfl | @craftsmanctfl | Oct 21 5:20pm

In reply to @northoftheborder "I'm at the other end of the spectrum because my PC wasn't discovered until stage 4,..." + (show)

It appears you made appropriate decisions and I hope you reap benefits from the treatment you’re receiving. It sounds like you already have. My concern about overtreatment would be generally at an earlier stage when a diagnosis of Gleason 7 (3+4) favorable is made. That seems to be the level that’s unclear as to treatment or surveillance. Many people at that stage do opt for treatment, even RP, because they don’t like the idea of having any cancer in their body. If that’s their preference, then I’m all for them doing it. It’s very much an individual decision in cooperation with one’s urologist and oncologist. Wishing you much success on your journey.

edmond1971 | @edmond1971 | Oct 21 6:49pm

You are on the right track. Occasionally people will say they are doing AS but in reality they are denying the situation, ignoring the lead time for readiness, and acting like the PCa will disappear. At your age and condition I think you are well positioned to do AS and also plan, adjust and be comfortable with the road ahead. There is much to learn, it's like owning a home… you need not be an expert at all trades, but at some point you'll need to talk the talk and walk where needed. Keep the faith!

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