You’ve probably heard the buzz about how prostate cancer is being over-diagnosed and over-treated.  The strategy, as I – a non-medical person – understand it, is that many cases of prostate cancer are the so-called slow growing kind. So rather than seeking aggressive treatment now (which can lead to urinary, sexual and bowel problems), you “MONITOR” your situation by taking regular PSA tests, getting DRE’s (digital rectal exams), and biopsies.

The thinking (I guess) is that some other health problem is going to kill you first. In other words – YOU DON’T HAVE TO DO ANYTHING NOW – we’ll just “monitor” you. If you’re a patient in denial, you will love this!  Hey guys, my doctor told me I don’t have to do anything now! Great!

Not so great.  The real challenge here, in my unscientific opinion, is how do you identify the truly low risk cases of prostate cancer?  How do you really know what you have? I am not a medical doctor, far from it, but it seems to me that it’s a scientific game of roulette.  Why do I say that?

The fact of the matter is – there’s a lot of scientific guesswork and estimation and prediction going on here. For example, see the Partin Tables.

(The only way to know the true facts of your prostate cancer is to have the entire gland analyzed in a lab after its removal in surgery.  That is, those men who choose surgery to treat their prostate cancer can get the full story afterwards.)

First, as many as 25% of prostate cancers do not produce high levels of PSA, so the PSA test may not alert you to these cases – that’s why you have to get DRE’s (digital rectal exams) too.

Secondly, biopsies only “sample” the cells in your prostate gland – they are nowhere near a 100% test of the whole gland. Your doctor is taking a very small sample of prostate cells in a biopsy procedure. In other words, if the 12 or so needle samples that your doctor takes in a biopsy miss the cancerous cells by a few millimeters or so, you may get a clean report.

Thirdly, and here’s the kicker, in those patients who had their prostate glands removed in surgery, the final lab test can reveal a much more aggressive and higher stage cancer than what was predicted or estimated beforehand.  Or the final lab test can show a weaker or less aggressive form of prostate cancer than what was predicted.  It can go both ways.

A 2014 Study in the British Journal of Cancer (Shaw, GL, et al), found that tests for prostate cancer underestimate the disease in half the cases.  In a total study group of 415 men, 209 men were found to have more aggressive cancer than originally thought. “In our unscreened population, tools designed to identify insignificant PC are inaccurate.”1 How were they able to determine this?  Because after surgery, the whole prostate gland is examined in a lab and the true extent and aggressiveness of the disease can be identified.

In addition, we have the case of Steve Jobs. Mr. Jobs had a “mild” form of pancreatic cancer – something called islet cell tumor that is rare and only occurs about 3-5% of the time. According to Walter Isaacson, Steve’s biographer, Steve waited nine months before he treated it.  Only after a new scan revealed that the tumor had grown did he agree to have it removed via surgery.  See more information on Steve Jobs pancreatic cancer here.

Prostate cancer is a very different disease than pancreatic cancer, but my non-medical take on it is that here we have a case where an individual chose to put off treatment for a “mild” form of cancer.  Now is that what I want to do?

That’s not how I want to go out, thank you very much. I detected my prostate cancer early, and I chose to treat it sooner rather than later.  That’s just me. Each case of prostate cancer is different, and you and your doctor may decide something completely different for you.

If someone were advanced in age and had a host of other serious medical problems, well maybe I can see how the Active Surveillance route might be one of the things they would consider.  However, you must always consult a licensed medical doctor about your specific case.

 

  1. http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2014192a.html []