Just like PCA .. lung cancer might be overtreated

This is true with many cancers. Skin, breast, even pancreatic.

But most fund cancers will be treated regardless. And for good reason. The best reason? We are trained to believe that our lives are saved by screening and/or therapies.

No need to step here again. Education is key for the PCa guy. Perhaps one day we get a better test that will make this a moot point.

Tony

I saw this last night. The study said 1 in 5 of CT scans detected tumors that were "probably" not life-threatening.

Seems to me these sorts of 'studies' are driven by ghoulish cost-cutting/austerity ideologies. We've seen this anti-human sentiment before with breast and prostate cancer testing.

"The American College of Radiology said in statement Monday that the earlier study showed lung cancer screening significantly reduces lung cancer deaths in high-risk patients and that the benefit 'significantly outweighs the comparatively modest rate of overdiagnosis' found in the new analysis.

"Low-dose CT scans are the only test shown to reduce lung cancer deaths in high-risk smokers, the radiology group said, adding, 'Overdiagnosis is an expected part of any screening program and does not alter these facts.'"

Bravo to the American College of Radiology.

The testing for all three saves lives. Doubt I have to do much arguing to convince anyone here of that.

The debate about overtreatment seems to boil down to this: until they can come up with tests to distinguish those tumors that will grow from those that won't, it doesn't really seem like overtreatment to me, it's more like hedging one's bets. However, there certainly seems to be a need for more information going into the treatment decision, so the patient can best weigh the odds against the consequences of treatment. In other words, if they told you that in 90% of cases like yours there would be no need for treatment, but that by going on active surveillance there would be a 10% chance of metastasis that treatment could prevent, what would you do? Better formulas for decision-making are needed, and hopefully ongoing studies will start to provide them. These are the kind of quandaries we're presented with in PC, and I guess in other cancers, too.

Thanks for posting this article, lifeguyd.   As you pointed out, definitely some similarities to PC.   I wouldn’t have known about this scenario with lung spots without reading this article…I don’t suppose many other laypersons would either. Like so many others, my mind had been conditioned to associate “cancer,” and in this case lung cancer, with miserable death.   I would have naturally assumed that if lung spots were found, the automatic response would be to drop a nuclear bomb on it. Prostate cancer has helped blaze the trail for improved care by becoming the medical poster child for overtreatment.   Not every case of prostate cancer automatically needs to be treated aggressively...and apparently the same is true of lung spots.   The article, which was written about lung cancer, draws this analogy to prostate cancer: “…the study shows how much understanding of cancer has evolved.   Decades ago, ‘every cancer was a bad cancer,’ he [doctor being interviewed] said. Now it’s known that certain cancers, including many prostate cancers, grow so slowly that they never need treatment.”   Similar to prostate cancers, nobody in the article has suggested stopping scanning or treatment for all lung cancer cases…but they are pointing out that harmless cases of “lung spots” are being overtreated and that at least some in the medical community believe it would be appropriate to improve this situation.   Also similar to prostate cancers, for the most part the doctors today understand that overtreatment exists (their “understanding of cancer has evolved,” in the words of the article) and want to do better.   To reduce overtreatment of lung spots, they (the doctors) need to expose “themselves” as the one’s doing the overtreating (and this articles helps serve that purpose).   This is also parallel to PC where many of the leaders of prostate cancer treatment care have exposed overtreatment in numerous “ we can do better than this ” themed articles, editorials, presentations, etc. as knowledge and education about the natural history of PC has evolved and matured. What may be unique to PC is the extent that a portion of the patient community is resisting change.     Post Edited (Casey59) : 12/10/2013 1:36:10 PM (GMT-7)

David,
Actually women have been very vocal about over treatment and research. This lead to the discovery of the BRCa-1 and BRCa-2 genes. It has also lead to less invasive therapy. (Lumpectomies or non-surgical therapies including surveillance programs).

I would hope men would be just as vocal about these options and possibilities.

www.cbsnews.com/news/mammograms-lead-to-breast-cancer-overdiagnosis-in-1-million-women-study-finds/

Tony

Post Edited (TC-LasVegas) : 12/10/2013 3:38:10 PM (GMT-7)

Geez...a patient community fighting to reduce overtreatment, and not being attacked for wanting to change/improve the status quo?  What a concept!  

(As I said above, the PC patient community is unique.)

Yes I am David,
And while they did not submit the mammogram recommendation it is still pending with the USPSTF. ODOT is not as big an issue with BCa as it is with PCa. I suppose that also figures into the equation.

Still that is not my point. Why would we not want better tools to allow men to avoid overtreatment? So screen away, but treat only when necessary is the same location that SGK is at. I think men should be there and all for it. I hope you put in as much heart and soul into finding better tools for more effective therapies as you do demanding more screening at earlier and earlier time frames.

That I would champion...

Tony

Absolutely Tony. If tests existed that could tell a person "your cancer will never cause you so much as the loss of a night's sleep" that would truly be a step forward for mankind.

Can someone define "over treatment"? AND, is it universally accepted?
There are guidelines that are fairly well accepted... NCCN.

Mikla,
Here are some interesting definitions:

www.ncbi.nlm.nih.gov/pmc/articles/PMC1913182/

Basically.

Overdiagnosis is the detection of a disease through screening that would have never harmed the patient.

Over treatment is after the detection of a disease, the aggressive treatment when none was needed for that patient.

As you probably have seen both are controversial terms and both are totally different in meaning. OD more used by physicians, and OT used by both patients and physicians.

Both can cause industry wide spread issues financially, physically, and mortally. The optimum word we would detect only cancers that would cause harm, and we would treat them only when needed or at the right time. PCa is mired in controversy here as it is one of the slowest moving of all cancers.

Tony

Mikla,
Very well said. With that approach I am certain you will make decisions that are right for you. And may peace be with you in your journey.

Tony

Bingo, Sephie! Your doctor wanted you to make an educated decision.   Anyone who has read anything about the PC overtreatment epidemic in the US today has come to learn that this is exactly what the most knowledgeable PC specialists are advocating for in our world, too…for men to not rush, uneducated, uninformed, into an irreversible aggressive treatment prematurely when no treatment may be needed.   Bingo!   Solid advice by your doctor. Newly diagnosed with low-risk PC?   Similar solid advice is:   Don’t rush your treatment decision.   Use your second, confirmatory biopsy (about 12 months later) to help you decide whether treatment is your next step.   In the mean time, you can learn more about low-risk prostate cancer and how it is not a thread to your life...despite the (current) use of the term "cancer I"  Become an informed, not a rushed, patient.  It’s as simple as that.  This is the message from the medical community. Newly diagnosed with intermediate risk PC, you are in the "gray zone," and your next steps might depend on numerous other factors such as your age, health, and most importantly the amount of Gleason pattern 4 cells found. Newly diagnosed with high risk PC, there is no question that immediate treatment is appropriate.  Which of the many treatment paths should, again, be individualized to other case background factors. We have emerged from the one-size-fits-all treat-everyone-as-though-treatment-will-"save their life," particularly if their life is not threatened...         Post Edited (Casey59) : 12/11/2013 6:46:21 AM (GMT-7)