NKinney said...
halbert said...
This is a good thing, I think we all agree.
Yes, halbert.
My crystal ball—which has been pretty accurate in the past—says that the count of low-risk PC cases on Active Surveillance will go
down in the next 10 years.
More specifically, the number of 3+3 cases on AS will go
down, but the number of 3+4 low volume cases on AS will continue the current
upward trend.
This will also be a good thing.
You: Hmmm, Norm. That’s very interesting. It seems counter-intuitive especially in light of the article Saipan Paradise posted today which said uptake of AS in low-risk cases in going
up. Why does your crystal ball say that AS cases will go
down?
Me: I’m glad you asked…
The “history” of prostate cancer screening and treatments is incredibly interesting. The more informed about
where we’ve been (including understanding—and accepting—the sordid past for what it is), the better we can understand where we are going and help advise others in the future.
Here’s some relevant history which helps set the stage for my latest crystal ball reading: I’m quite sure that many of our longer-term members
are familiar with the movement to “re-name” low-risk PC cases so as to
exclude the word “cancer,” and ultimately with the objective to reduce PC overtreatment which was florishing. But I’m also fairly sure that many of our newer members may be familiar with PC overtreatment, but
are not familiar with the movement to "re-name" low-risk PC.
Back around the turn of the decade, many leading PC care providers & pathologists rallied around several re-naming proposals—all were rooted in the notion that the word "cancer"
used to mean a disease that would metastasize and that you could/would die from; but with evolutionary changes to the Gleason naming conventions, this was not the case any longer; specifically with Gleason 3+3. (Interested in more about
this? Simply google the words: prostate IDLE tumor.)
The re-naming proposal supporters were responding to the observed patient “cancer hysteria” which (quite naturally) set-in
immediately after a “cancer” diagnosis which instinctively triggered the “get it out now” reaction, despite the understanding (even then) that data did not support the need for aggressive treatment for favorable-risk cases. Illustratively, Dr. Otis Brawley was quoted in this recent (the OP’s) Wash Post article: “
Remember that until 2010, a man diagnosed with prostate cancer was told to get your prostate out, next week at the latest.”
There was a fierce dis-approval for the “re-naming” proposals from a community of patients who had already been (over)treated who were convinced, not unbiasedly, that despite evidence to the contrary, screening and aggressive treatment "
saved their lives." With all the personal, emotional, physical and financial "investment" that overtreated men of the era had put into getting treated, they just couldn't see that the data was correct. (Can you say “cognitive dissonance?”) So we slogged forward, and the scourge of the low-risk PC overtreatment epidemic gave prostate cancer a “bad name.”
Looking forward from today, in the
next 10 years, technology will help to achieve the same endpoint that re-naming low-risk PC sought to accomplish. There will be fewer low-risk “cancer” cases on the books (and with fewer low-risk diagnosis, the number of AS cases will go
down). We’ll just stop diagnosing it so frequently.
Here’s why.
Over the next few years, the increasing use of mpMRIs will lead to fewer blind biopsies and more targeted biopsies in patients with visible lesions. Remember that mpMRI is pretty good at ignoring low-grade PC. So men that don’t have anything visible are probably going to be biopsied less and less, and correspondingly there will be a significant reduction in the number of 3+3 cases
diagnosed. Fewer low-risk PC cases diagnosed will result in the count going down (but not necessarily the percentage) of low-risk cases going onto AS, fewer cases of (unnecessary) “cancer hysteria,” and all around better health for men. And
that’s a good thing.That’s what my crystal ball says…even if it may seem counter-intuitive.
Post Edited (NKinney) : 5/16/2018 3:48:14 PM (GMT-6)