A Yooper said...
Interesting stuff in this decision-analysis study - although as with all statistics we need to keep in perspective the targeted population, in this case: "Men aged 65 and 75 years who had newly diagnosed low-risk prostate cancer...
A Yooper, this economic study included only men in the very narrow age range of 65-75. Other studies might have focused on other age ranges and might have gotten other results, but this study only focused on that one group. But that's just this study...
But be aware that age is not a contra-indication for active surveillance. These are Dr Klotz's words, not Dr Casey's. The longer a patient's life expectancy, the more stringent should be the criteria. Men of any age who submit to an unnecessary aggressive PC treatment potentially have a lot at stake; some would say that younger men may have more to lose, so one wants to be sure—at ANY age—not to over-react and rush to treat their fears rather than treat the disease.
As the Prostate Awareness Foundation wrote, "this is not your dad's prostate cancer." Today, it is easier to find smaller tumors; >90% are clinically localized (and many of those are indolent). In the last 2 decades, there has been profound stage migration.
The main advantage of AS for low-risk men (and AS is ONLY applicable to low-risk men, today) is an avoidance of the collateral damage and short-term, long-term, late-term loss of function (sexual; bladder control) that are associated with a decrease in the quality of life. If AS is something one is interested in, the common suggestion is to consult with a physician group that has considerable experience in the management of prostate cancer patients on active surveillance protocols before a treatment decision is made. If one decides to proceed with an aggressive treatment, we would similarly recommend consulting with a highly experienced surgeon/radiation oncologist.
Keep in mind that if one should further consider AS, it is possible that: (a) you might never need treatment at all; (b) you might not need treatment for years; (c) you might need treatment 6 months from now. But, if you do follow AS and then later seek deferred treatment, you should also know that as a whole men who have followed similar paths have essentially the same treatment outcomes as similar groups of men who seek immediate treatment. Furthermore, you should also know that there are lifestyle choices (diet, exercise, stress reduction) most leading AS doctors recommend which may help to influence a more favorable AS outcome.