Summary Of Sky
Why are many doctors still lukewarm about active surveillance? Here are some thoughts:
The concept of watching cancer instead of treating it is uncommon in general oncology since there are only a few rare cancer types that have an established methodology for active surveillance. Adapting to this radical new way of thinking takes time.
Doctors are concerned about lawsuits if the cancer were to spread.
The world is changing rapidly. It’s difficult to stay abreast of all the changes. Due to having only partial knowledge, many doctors remain unconvinced that active surveillance is truly safe.
Due to the short nature of a typical doctor visit, it is challenging for doctors to find enough time to teach patients all the ins and outs of why active surveillance makes sense. It’s more time-friendly to offer patients what they are already expecting—treatment for their cancer.
Treatment pays the doctor far better than observation does.
The medical community fumbled badly in the 1960s when it labeled Gleason 6 a “cancer.” We now know that Gleason 6 never metastasizes. Therefore, it fails to meet even the minimum requirement of being defined as a cancer. Despite an abundance of scientific support for active surveillance many doctors and patients are still frightened. The perceived danger from “cancer” causes patients to overlook the possibility of lifelong, irreversible side effects from treatment. The medical industry, due to time constraints and mixed motives rarely offers the emotional support patients need to adopt a go-slow approach. Patients struggle to overcome their preconceived ideas about the deadliness of cancer. In addition to all of this, family members are also frightened, and tend to insist on treatment. It’s no wonder that many men are attracted to surgery. They believe that cutting out the prostate will bring them relief from all the emotional uncertainty.
The Drawbacks of Active Surveillance
The biggest concern for men contemplating active surveillance is that the initial random biopsy may have missed a higher-grade tumor. Most centers address this problem by doing random biopsies every couple of years, which are unpleasant, can cause serious infections, increase the risk of impotence, and worsen urinary symptoms. Thankfully, recent studies now show that MRI (Chapter 4) is an excellent alternative to having repeated random biopsies.
Living with Cancer
Anxiety and uncertainty about living with untreated “cancer” is certainly a problem. Some degree of anxiety, however, is inescapable. Studies show that men who had surgery or radiation also struggle with fears that the cancer may come back. Men in Sky need to guard against rushing into unnecessary treatment. Too often their treatment ends up being associated with irreversible side effects.
Mark Scholz, MD is the Executive Director of the Prostate Cancer Research Institute. He is also the Medical Director of Prostate Oncology Specialists Inc. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center. He is co-author of Invasion of the Prostate Snatchers. He has authored over 20 scientific publications related to the treatment of prostate cancer.