A comprehensive view of European AS programs and data.

Good piece, John, but I thought the key to the whole article still boils down to this quote from it:

" but we have no way to really define “indolent” disease"

Until we do, there is always going to be that element of chance or guessing or even hoping, instead of
knowing for sure if a particular cancer is truly indolent or not. Sure can't be known for sure based on
a Gleason, a Staging, or PSA number, as even among our own group of men, some of our cancers in
reality turn out to be more aggressive and in need of treatment than the "facts" or data would indicate.

Good information there, though, enjoyed reading it.

Thanks,

David

I find he following to be problematic issues:

- The longest, published, median follow-up period in any of these studies is still only 6.8 years (although data have been reported at medical/scientific symposia based on longer follow-up periods).

- Up to 33 percent of patients receive deferred therapy after a median of about 2.5 years of surveillance.

But I can agree with the following as long as the individual chooses to do so:

"The National Comprehensive Cancer Network (NCCN) guidelines strongly recommend monitoring as the primary, first-line form of management for two groups of men:

Men with a life expectancy < 20 years with very low-risk prostate cancer (defined by a clinical stage of T1c, a PSA level < 10 ng/ml, a Gleason score of ≤ 6, a PSA density of ≤ 0.1 ng/ml/g, fewer than 3 biopsy cores positive for cancer, and ≤ 50 percent of any positive core to be cancerous)
Men with a life expectancy of < 10 years with low-risk prostate cancer (defined by a clinical stage of T1-T2a, a PSA level < 10 ng/ml, and a Gleason score of ≤ 6)"

Reading between the lines, to control costs in government health-care programs, they are hoping as many men as possible will die from heart attacks before they have to treat them for PC....On the surface, there is nothing wrong with this, but it allows many men with high-risk disease to slip through the cracks..If active treatment is going to be withheld, then the biopsy process needs to be made more certain in its findings so the cracks can be made smaller....