Why Are More Men Choosing to Avoid Prostate Cancer Treatment?

You might assume that, upon diagnosis of a malignant tumor, your immediate reaction would be to run screaming to the nearest clinic, demanding its immediate removal at any cost – and while historically, this reaction would be typical, this attitude is fast changing. As counter-intuitive as it may seem, up to 50% of men diagnosed with early-stage prostate cancer are choosing to avoid surgery and chemo [1], opting instead for an approach called ‘active surveillance’ – a fancy sounding name for doing, well, not too much.

What’s more, this approach is now being championed by major research organizations such as the National Institutes of Health and the American Society of Clinical Oncology – but why is “no treatment treatment” so quickly becoming the most popular option? What factors should influence your decision-making process when it comes to treatment? And is active surveillance the right option for you?

The prostate dichotomy

The active treatments for prostate cancer – surgery, radiation therapy and chemo – have a range of unpleasant and disruptive side effects: incontinence, erectile dysfunction, fertility loss and bowel dysfunction in addition to the standard side effects of cancer treatment procedures such as nausea, vomiting and hair loss [2]. It is understandable, therefore, that one might wish to avoid suffering such side effects unless absolutely necessary – however, the dichotomy that prostate cancer sufferers must consider is that when cancer is detected early (which is when it is the best candidate for active surveillance), it is simultaneously low-risk yet at its easiest to cure stage.

When the cancer is still confined to the prostate, treatments are most likely to be curative [3] – but do you want to suffer the significant side effects before it is absolutely necessary?

Age is more than just a number

This is where age, health, life-expectancy and quality of life come into play. Like most cancers, prostate cancer grows much more slowly in older patients [4] and one study of 3000 men with prostate cancer found that older patients with co-morbidities are far likelier to die from one of these other conditions than from their cancer [5], and autopsy studies of men over 50 who died from other causes have found that almost 30% of these man had histological evidence of prostate cancer [5].

This isn’t to say that prostate cancer shouldn’t be of concern in older men – simply that, if your life expectancy is such that you may not live long enough to see side effects from your cancer anyway, you may wish to consider active surveillance, rather than invasive treatment procedures.

But what about younger men, who may be even keener than their older counterparts to avoid side-effects from treatments? Active surveillance involves committing to regular biopsies, where a small area of the prostate is removed and analyzed to ensure the cancer isn’t progressing – and there’s also the additional stress-factor of knowing that you are living with cancer in your body. The word “cancer” has such a unique power to terrify that some doctors have even called for a new label for prostate tumors which better communicates their slow growth rate and low-risk nature [1] – so are they really worth suffering surgery for?

Ultimately, it’s your tumor and ought to be your decision – so when you’re consulting with your doctor or urologist, make sure you’re being offered the full scope of treatment options. Don’t be pushed into treatment routes which you’re uncomfortable with – seek a second opinion, do your own research and consult with your loved ones – just as there’s no “one size fits all” cancer, there’s no ubiquitous cure to suit all needs, either.

This article was provided by The Wellman Clinic.

References

[1] Kolata G. More men with early prostate cancer are choosing to avoid treatment. New York Times 2016 May 24

[2] Side effects. Prostate Cancer Foundation

[3] Schmitz M. Natural history of prostate cancer if left untreated. Very Well 2017 Feb 1

[4] Browner I. Applications in geriatric oncology. Johns Hopkins Medicine

[5] Irwin K. No-treatment approach may be best choice for older prostate cancer patients. UCLA newsroom 2013 May 20

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