Take time to choose treatment options
This week, a big thanks to Dr. Freddie Hamdy, professor of surgery, Oxford University, England.
Why? Because, for many years, I’ve advised readers who are diagnosed with early prostate cancer to take their time when deciding which treatment is best for them.
Some authorities have disagreed with me. Now, I can legitimately say, “I told you so”.
Does this mean I’m smart? No. I was just lucky years ago to interview Dr. Willet Whitmore, a world authority on prostate cancer, at Memorial Hospital in New York City.
At the time, Whitmore remarked, “The survival rate of this cancer has little to do with the type of treatment. Rather, it’s related to the biological nature of the cancer.” In other words, how malignant is the cancer? Some cancers are pussy cats, others raging tigers.
Now, Hamby says, “We have learned that prostate cancer, detected by a PSA blood test, grows very slowly, and very few men die of it when followed over a period of 10 years, only around one per cent, irrespective of the treatment assigned.”
Researchers followed 82,000 British men who had taken a PSA test. Of those, 2,700 were diagnosed with prostate cancer. Of this number 1,643 agreed to be randomly treated by either surgery, radiation treatment or regular surveillance to detect whether the cancer spread.
The result? The study, reported in the New England Journal of Medicine, showed that all three treatments resulted in very low rates of death from prostate cancer. Those men who decided on active surveillance, showed a slightly higher risk of the cancer spreading, but not a significant risk of dying, after 10 years.
Further words of wisdom expressed by Whitmore have proven true. He stressed that deciding on either surgical or radiation treatment can be associated with troubling complications. This was confirmed by the recent Oxford study.
For instance, several months after surgical treatment, nearly half the men complained of urinary incontinence and were forced to use diapers. Moreover, after surgery, 88 per cent could not have an erection, compared to 78 per cent treated by radiation.
Radiation therapy, however, also caused more bowel problems than those treated by surgery.
But men who waited and were followed by active surveillance did not get off scot-free. Eventually, 50 per cent required either surgery or radiation treatment. But this also delayed potential complications.
Every year 24,000 men in Canada and 180,000 in the U.S. are diagnosed with prostate cancer by the controversial PSA test. Currently in Canada, the test is not recommended. Advocates of the test say this is a tragic error as they claim it saves lives. Others say it’s diagnosing too many men with cancers that are slow-growing and may never kill them. In addition, needless treatment results in troubling complications.
This is why Whitmore claimed the PSA test should not be done in men over the age of 65.
Why? Because they will, in all probability, live another 15 years without treatment. So why take the risk of worrisome complications?
It is well to remember these facts. Autopsies show 50 per cent of men age 70 have prostate cancer and one of three over 85.
Moreover, although one in seven men is diagnosed with this disease in his lifetime, only one in 28 men die of it. Obviously this shows that not all men need to be treated.
As Whitmore remarked, “Getting older is invariably fatal, cancer of the prostate only sometimes!”
The final decision of how to treat early prostate cancer must always be a decision between the patient and his doctors. This study shows that anyone diagnosed with an early prostate cancer doesn’t need to make a decision within 24 hours.
Some men may decide they cannot live knowing they have a small amount of cancer and it must be treated.
Others, knowing the results of the Oxford study, will accept a watchful waiting approach and conclude it is better to live with the devil you know, than face the possible complications of treatment.
So it requires the wisdom of Solomon to determine which way is the best to treat this unique malignancy.
It is also ironic that Whitmore died of this cancer. Dr. W. Gifford-Jones is a syndicated columnist whose medical column appears in The Guardian every Tuesday. Check out his website, www.docgiff.com, which provides easy access to past columns and medical tips. For comments, readers are invited to email him at info@docgiff. com. He can also be found on Twitter @ GiffordJonesMD.