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.