The More Things Change the More They … Stay the Same

BY MARK SCHOLZ

Everyone knows there is overuse of surgery and radiation in the United States for men with Low-Risk prostate cancer. But do not assume increased awareness means things are getting better.  Actually, they are getting worse. 

A study in the February issue of this year’s Archives of Internal Medicine reports that in 1999, 38% of men with Low-Risk prostate cancer received unnecessary treatment.  By 2007 that percentage was up to 52%.  Another study published in this year’s February issue of the Journal of General Internal Medicine reports that one-third of men queried after radical prostatectomy could not even remember being offered any other option than surgery.

Monitoring rather than treating Low-Risk prostate cancer became a mainstream approach in 2007, when Dr. Peter Carroll at University of California at San Francisco convened a conference of more than 200 experts who unanimously validated active surveillance for men with Low-Risk prostate cancer.

So what was the result?

Over the next year, surgery increased 10% from 80,000 annually in 2007 up to 88,000 in 2008 (New England Journal of Medicine, August 2010).

How can this be? Don’t doctors put their patient’s best interests first? 

The average patient fails to realize that surgeons are a unique sub-classification of doctors.  If an average doctor is likened to army infantry, then surgeons are the Navy Seals. Highly-trained, talented and very mission orientated. (For more insight on Navy Seals, check out Act of Valor which is playing in theatres now.)

Surgeons experience the satisfaction of eradicating disease by cutting it out. However, they don’t come by this privilege without intense training involving great personal sacrifice.  Once they get their wings, they are part of an elite fraternity that rightly or wrongly considers itself the best of the best. Who is to tell them otherwise?

These surgeons, known in the prostate world as urologists, stand at the entry hall welcoming the 200,000 newly-diagnosed men every year who have a positive biopsy. Urologists do all the biopsies. Cutting the disease out is at its core exactly what the whole life of a urologist is about.  As the old saying goes, when you’re a hammer, everything looks like a nail.

If urologists won’t spread the word about active surveillance then who will?

There is no easy answer because men with newly-diagnosed cancer are frightened.  Naturally, they want a quick fix.  The option of surgery, enticingly presented by the urologist, fits that bill.

The best hope for change lies in the more than two million prostate cancer survivors.  Entreaties from close friends or families can slow the charge to surgery.  Most men, if given time to really examine their options, discover that other treatment options including monitoring leads to better results than surgery.

 

My personal frustration regarding this over-treatment motivated me, a journalistic amateur, to sit down and write a book. “Invasion of the Prostate Snatchers” is designed to give prostate cancer survivors a tool they can give their friends and family to explain why active surveillance is safe and to help open the eyes of men who wrongly think that prostate cancer is a death sentence.