RE: Re: Treatment Decisions in Patients with Low Risk Prostate Cancer

[Guest guest]

When I was first diagnosed with prostate cancer and learned that

there is more than one approach to dealing with it I thought,

I'll read the literature, find out what the consensus view of

the best scientists and doctors is, and do that. But as all of

us who have been down that road now know, it's not that simple.

It turns out that experts don't all agree, and we don't know for

certain when treatment is required, what the best treatment will

be, whether it will work and for how long, or what side effects

we're going to have.

Then on top of all that, we find that personal preferences

really do play a role in what we should do.

Imagine that you have been told that you have a cancer that has

a 25% chance of becoming dangerous during your lifetime. If you

get treatment, you won't know if the cancer is cured, but the

odds are now that you only have a 10% chance of the cancer

becoming dangerous. However the treatment gives you a 50%

chance of long term impotence and a 50% chance of long term

incontinence.

What do you do?

You might choose treatment and get the best outcome - no cancer,

no impotence, no incontinence. Or you might get the worst

outcome - impotence and incontinence, and you still have cancer.

Alternatively, you might choose no treatment and get the best

outcome - no symptoms from your cancer and no side effects of

treatment. Or you might get the worst outcome - an agonizing

disease and death ten years before you might otherwise have gone

by a peaceful heart attack.

" Active surveillance " is something of a middle course. You

don't reject treatment, but you decide to wait and see whether

and how much the cancer grows before you opt for treatment.

This approach may incur more risk of cancer death because it

gives the cancer more time to become metastatic, but it also

gives you more information about whether the cancer is really

dangerous and really needs treatment, and also gives you more

time without the risks and side effects of treatment.

If I were a doctor, I think I'd advise most of my patients that

had signs of aggressive cancers to seek immediate treatment.

However for patients that appear to have indolent cancers I'd

explain the advantages and disadvantages of each course and

encourage the patients to take a little time and consider the

issues, consider their own circumstances, and consider their own

priorities, before deciding.

Alan