Fans for the Cure has built upon our initial awareness campaigns about the importance of a baseline PSA test for prostate cancer to encouraging men who are diagnosed to seek out the most medically sound treatment options based on the risk factors/Gleason scores for their individual cases.
Low-Risk Cancer Treatment: Active Surveillance
As we have often written in this space, a treatment option being chosen more frequently these days by men with low-risk cancers is active surveillance. As the Sloan-Kettering website points out, it’s a natural reaction to want to excise cancerous tissue ASAP. But not all prostate cancers require such aggressive treatment, especially given that nine of ten cases diagnosed are localized, i.e. confined to the prostate. In addition, active surveillance minimizes exposure to some heavy-duty side effects of surgery, complications that include impotence, incontinence, and infections. Many urologists now recommend active surveillance when the cancer is localized and unlikely to metastasize, shows no symptoms, and is slow-growing,
An issue raised in an article published by Karen Hoffman, MD, MPH, of MD Anderson Cancer Center in Houston documents that rates of active surveillance among diagnosing urologists varied from 4.5% to 64% of patients. Attempting to explain the large variance, Dr. James Mohler of Roswell Park Cancer Institute in Buffalo, N.Y. said, “Urologists and radiation oncologists believe in their treatment modality and, hence, are biased by their beliefs and sometimes by financial considerations.”
“We weren’t necessarily surprised by the findings, but the extent of variation in management of low-risk prostate cancer across physicians was quite striking,” Hoffman told MedPage Today back in 2014.
The clear evidence of significant variation in doctors’ approaches to treatment plans has shifted the responsibility to patients with low-risk prostate cancer to take the initiative and ask whether they are candidates for active surveillance. In the MedPage article, Dr. Hoffman and others were pushing for the public reporting of doctors’ treatment histories, allowing primary care doctors to more easily seek out those urologists who are more inclined to recommend the less invasive observation option for low-risk cases of prostate cancer.
Dr. Mohler, who also is chair of the National Comprehensive Cancer Network (or NCCN) prostate cancer guidelines panel, was also quoted in the article as saying: “Patients and the primary care physicians who care for them should encourage [NCCN] guideline-compliant counseling, care, and outcome monitoring, which can be accomplished most easily by obtaining a second opinion at one of the 45 NCCN member institutions.”
Treatment Decisions: Seek Out the Best Treatment for You
Again, we want to get out the message that men with low-risk cases of prostate cancer should at least be considering active surveillance among many treatment options. But as Doctor Hoffman shows us with her research, the range of treatment options among doctors treating men with low-risk cases of prostate cancer is wide indeed, for any number of reasons. We strongly suggest consulting with the NCCN or with our confidential questions page at Fans4thecure.org to find a highly qualified doctor located in your area whom you can seek out for informed second opinions for treatment options that are consistent with the risk factors of the specific case of prostate cancer.
Read the article about treatment decisions: http://www.medpagetoday.com/urology/prostatecancer/46769