Overtreatment of Prostate Cancer
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.