Let the Buyer Beware

BY MARK SCHOLZ, MD

It’s time to change our preconceptions about prostate cancer and “reboot” the way we think about what typically is a non-life-threatening disease. Ever since the FDA first approved PSA testing in 1987, prostate cancer has grown into an aggressive multibillion dollar industry. Marketing hype has created the impression that treatments like Proton therapy and robotic surgery are universally desirable, even though well-informed patients know this is hardly the case.  How did the prostate cancer world deviate so far off the originally intended tract of helping patients? And what can be done to set things straight?

Ten years ago the experts believed that immediate curative treatment was needed for every man with prostate cancer.  Today, after 20 years of vigorously detecting and treating every case of prostate cancer, it has become clear that almost half of the 230,000 men diagnosed every year are undergoing radical treatment for a cancer that is incapable of metastasizing.  Now it’s time for the medical community to come to grips with the fact that over a million men in the United States are living with impotence and incontinence for no justifiable reason. This is a disaster of gargantuan proportions.

Shockingly, even though we can now readily identify these harmless cancers, the problem of rampant overtreatment continues. In 2015 another 50,000 men will undergo unnecessary radical treatment. The medical industrial complex that has been gaining momentum for 25 years refuses to confess its tragic errors.  The huge investments in enormously expensive medical equipment need to be paid off.  No one is willing to accept responsibility, make apologies or confess wrongdoing for all the overtreatment.  The existing system is entrenched and the doctors are too comfortable with the status quo.

Reversing the momentum of twenty-five years of recommending unnecessary radical treatments is going to require the patients to protect themselves.  They need to become far more medically sophisticated consumers.  Five years ago, Ralph Blum and I fired the first salvo by writing Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency. In our book, we attempted to defang the poisonous and fear-inducing word cancer by renaming the low-risk type that does not metastasize “The UnCancer.”  Our book has been helpful at revamping the gross misconception that every prostate cancer is potentially deadly.  Invasion provides an excellent introduction to men with newly-diagnosed cancer by presenting the important concept that prostate cancer comes in three broad types: low, intermediate and high-risk.  

One of the important themes introduced by Invasion is a healthy mistrust of physician motives. For protection against patients receiving the wrong treatment, Invasion argues strongly for patient empowerment through education. The term, “prostate cancer” is merely an umbrella term for a broad spectrum of illnesses that behave very differently. The book simplifies the treatment decision making process by clearly identifying the three major subtypes of prostate cancer, low, intermediate and high-risk.  Once patients have gained an accurate understanding of where they fit into this individualized schema, an informed treatment decision can be made.  As a medical oncologist, rather than a surgeon, the information provided in the book is unbiased with clear presentation of all the risks and benefits associated with all the different treatments that are available.

In an era now past, physicians were trained to put their patient’s interests ahead of their own.  Today, patients need to adopt defensive tactics that are realistic about how prostate cancer care has become a highly lucrative business. The patient who assumes that their counseling physician represents his best interests, is on the cusp of making a dangerous mistake. Bluntly, the prostate cancer world has evolved into a sophisticated and well-oiled business and the buyer better be on guard.