This is a nice update to Johns Hopkins’ long-term ongoing work.
There were no real surprises in the Johns Hopkins update, but I am (again!) amazed at the comments from HW/PC “veterans” portraying confusion or unfamiliarity with the basic fundamentals of Active Surveillance for prostate cancer patients. I’m not being critical,
but these comments help clearly illustrate why we need to advocate hard on the need for better “patient education,” and how truly important it is to keep the dialogue on AS at the forefront of HW/PC discussions…for the benefit of our soon-to-be-diagnosed brethren who know even less about
AS. After all, men in the low-risk category—the men who may be well suited for AS—are the highest percentage of newly diagnosed cases.
These AS fundamentals, motivated by some of the comments above, should probably be added to the “Newly diagnosed…” thread:
ACTIVE SURVEILLANCE FUNDAMENTAL #1:
AS is only for well-selected men diagnosed with PC. This is why “Step #1” for newly diagnosed men is to understand your risk category (see “Newly diagnosed…” thread). AS is not for men with high risk cases. Intermediate risk…maybe. This category has been split into two groups: 4+3 unfavorable intermediate risk cases, and 3+4 favorable intermediate risk cases, with other case characteristics also weighing-in. A number of AS programs have been including favorable intermediate risk cases. Low risk cases are the obvious candidates, and Johns Hopkins has had strict guidelines (although they have relaxed their AS criteria a couple years ago).
AS FUNDAMENTAL #2:
Some men who originally qualify for AS end up moving onward at a later date to a deferred treatment if signs indicate degradation in case characteristics. These men with deferred treatment are also “AS success stories!” (Please study and understand this PC Infolink article if you are confused by that statement:
prostatecancerinfolink.net/2010/10/19/understanding-your-clinicians-mindset-about-active-surveillance/) The program worked for them, too, by showing them if and when treatment was appropriate. Complementary research has demonstrated that men on AS who move to deferred treatments have essentially the same outcome as those who sought immediate treatment.
AS FUNDAMENTAL #3:
Ongoing monitoring is important to the continued success of AS programs and men enrolled in AS programs. Annual PSA blood tests are the norm. In the past, on-going AS cases have follow-up biopsies (after the 2nd, confirmatory biopsy) on an every 18-24 month basis (typically), depending on the program. In the current decade, mp-MRIs have been found to be superior to the old standard ultrasonic-guided needle biopsy, and most AS programs now at least intersperse mp-MRIs with needle biopsies.
Anyone else want to suggest another “AS FUNDAMENTAL” which might also benefit low-risk newcomers?
Post Edited (JackH) : 9/1/2015 12:18:10 PM (GMT-6)