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Early Prostate Cancer

"The treatment of men with early-stage prostate cancer has undergone a sea change. Five years ago, nearly all opted for surgery or radiation; now, nearly half are choosing no treatment at all.

The approach is called active surveillance. It means their cancers are left alone but regularly monitored to be sure they are not growing. Just 10 percent to 15 percent of early-stage prostate cancer patients were being treated by active surveillance several years ago. Now, national data from three independent sources consistently finds that 40 percent to 50 percent of them are making that choice."

See NY Times Article by Gina Kolata.

This is an important article.  Another concept is that PSA tests are done unnecessarily which leads to  to unnecessary biopsies which leads to diagnosis of early prostate cancer and then surgery or radiation.  Patients travel down this slippery slope.

PSA Update 2016

A recent article by H. Gilbert Welch and Peter Albertsen in the NY Times describes where we are at with PSA testing and prostate cancer screening in 2016.

The case against prostate cancer screening is strong. The heterogeneity underlying cancer can be described through the metaphor of birds, rabbits and turtles. The goal of early detection is not to let any of the animals escape the barnyard and cause a cancer death. But the birds have already flown away. They are the most aggressive cancers, the ones that have already spread by the time they are detectable, the ones that are beyond cure. The rabbits, potentially lethal cancers that might benefit from treatment, are ready to hop out at any time. These are the cancers we hope to control with early detection.

Then there are the turtles — these are nonlethal cancers that aren’t going anywhere. Screening is really good at finding these cancers, and the prostate gland is full of them. Over half of men age 60 and older have small, indolent, nonlethal prostate cancers — many more than those who have harmful ones. That’s why men are much more likely to die with prostate cancer than from it.

It is well worth a careful reading.