BY RALPH BLUM
five years since writing our book, Invasion of the Prostate Snatchers, with the subtitle “No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual
Potency,” Mark and I have continued advocating for changes in the
management of low-risk prostate cancer. It has been an uphill battle, mainly
because most men find it hard to believe that anything called “cancer” can be
safely monitored, probably for years, even—in my case, for example—for decades.
long last, it appears the word is out: Finally more men are opting for regular,
close monitoring, while holding off on aggressive treatment unless the disease
progresses. Instead of yielding to an overwhelming desire to
"cut the damn cancer out and be done with it," men are increasingly
choosing "active surveillance" and by so doing, dodging the two
bullets of erectile dysfunction and loss of urinary control.
study published in JAMA this month, Dr. Matthew Cooperberg and Dr. Peter
Carroll of the University of California, San Francisco, drew on data from
10,472 men with localized prostate cancer, who were treated at 45 urology
practices in 28 states, between 1990 and 2013. The use of active surveillance
among men with low-risk cancer ranged from 7 to 14 percent from 1990 through
2009, then increased to 40 percent between 2010 and 2013. Among men age 75 or
older, 76 percent opted for active surveillance.
active surveillance in the U.S. have historically been lower than in other
countries. In Sweden, for instance, 2013 figures indicate that active
surveillance was used to manage 78% of men with very low-risk disease, and 59% of men with low-risk disease.
Unfortunately, men in this country have been motivated to submit to radical
treatment for what is typically a non-life-threatening condition.
years ago, a PSA reading of 4.0 was considered "abnormal," and
triggered an immediate biopsy regardless of age or prostate size. More recent
studies show that microscopic amounts of low-grade prostate cancer are so
common, that even when the PSA is totally normal, one-fourth of men will have a
positive biopsy. So if the biopsy was positive, inevitably it led to
radical treatment; treatment that, in most cases, was unnecessary. Fortunately
this is changing.
however, are still frightened into unnecessary aggressive treatment. They don't
want the stress of regular check-ups. They just want to be rid of the cancer.
But fear is an untrustworthy advisor. What they don't take into account is that
men who have chosen surgery also have
to be monitored regularly to make sure their cancer stays in remission.
So if you
are blessed with the low-risk, slow-growing form of this disease—the tortoise
of prostate cancers— wait and go slow. Your three most important
considerations are quality of life,
quality of life, quality of life. With active surveillance you avoid
the toxic side-effects of radical treatment, without sacrificing the chance for
a cure, even if the disease progresses.