This is a new era of prostate cancer care, but patients and doctors are still not getting the message

The new normal

This is completely mystifying to me. This should not be happening.

Warren Buffett gets radiation treatment for localized prostate cancer. And now Jerry Brown does the same?

What are these guys and their doctors thinking? We are WELL into the 21st century. That’s not how we do it anymore. You don’t give a potentially dangerous treatment to patients who have one of the least dangerous cancers.

What makes it mystifying is that you would expect Buffett (a famous billionaire) and Brown (the governor of California) would have access to the best medical advice money can buy.

And yet, their doctors are treating them along 1990s guidelines.

Go figure. Maybe they’re just very headstrong patients who “don’t want to take a chance.” In that case, their doctors should drop them as patients. Because there’s no reason to take chances with treatments that do more harm than good.

But choosing radiation isn’t the only treatment misstep that prostate cancer patients can make…

Ten years after

The keyword here is “localized.”

Most prostate cancers grow slowly. So if a cancer is localized — that is, it hasn’t spread beyond the prostate — then it’s almost never a dangerous issue for older men.

That was the thinking behind a recent study that reviewed 730 cases of localized prostate cancer. The average age of the subjects was about 15 years younger than Buffett (81), and a few years younger than Brown (74).

In half of the men, surgeons removed prostates. Men in the other half were “observed.” They weren’t treated. Doctors screened their PSA levels.

After 10 years, there was very little difference in death rates between the two groups. The difference was so small that it landed within the possible margin of error.

Meanwhile, more than 20 percent in the surgery group suffered complications from their surgery. One death was linked to surgery.

Let’s make this as simple as possible. Doctors should not rush to treat most men with localized prostate cancer. Period. No surgery. No chemo. No radiation. And this is especially true for men in their 70s and beyond.

Men? Doctors? Are you getting all this? It could hardly be more important! Let’s not wait years for the standard of care to change. We wish Buffett and Brown all the best, of course. But almost nobody with their circumstances should take the aggressive course of action.

The one possible exception is a new technique I’ve told you about called high-intensity focused ultrasound. In HIFU, ultrasound heats and kills prostate tumors. It’s highly effective, and adverse effects are minimal.

Every man deserves to know that we’re in a new era of prostate cancer care. All the heartache and misery that comes with unnecessary treatment is just so last century now.

Sources:
“Radical Prostatectomy versus Observation for Localized Prostate Cancer” New England Journal of Medicine, Vol. 367, No. 3, 7/19/12, nejm.org

“Prostate cancer surgery fails to cut deaths in study” Gene Emery, Reuters Health, 7/18/12, reuters.com