Why do we treat prostate cancer?

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As you surely have heard, there is a movement to “observe” prostate cancer.

This seems like a plausible options for many people.  And yet, it is very misleading and greatly misunderstood.

 

This is not the first time this option has been popularized. 30 years ago similar reports were published saying there was no increase in lifespan in men who had their prostate cancer treated and those who didn’t.  Now we have a new campaigne to promote the same idea.  And the rational is the same, but the methods are a bit more refined now as compared to the 80’s.

The idea is we spend too much money treating old men.

The idea is we are using old men as a source of income and we are causing harm.

The idea is we should be natural and let nature take’s course.

 

Please allow me to point out a few errors in thinking.

1.  This is not a new idea.  It is an unfortunate over reach of the standard medical rule “the treatment must result is a better outcome than than the risks”

2.  The goal in treatment of prostate cancer is not longevity.  It is quality of life.  The quality of life to be able to pee, be free of painful metastasis, to have erections and sex and control of emotions.  This is the quality that should be decided for each man.

3.  Harmful and risky procedure for treatment should always be avoided, as in any medical option.  Unfortunately there are a basketful of choices in accepted prostate cancer.  And may of them are barbaric and done carelessly. This is not a reason to avoid treatment.  This is a reason to choose wisely.

4.  Money is saved only if you assume there will be no treatment–EVER.  Even when the prostate gets so big as to cause massive pain in the pelvis, or spreads to the bones and you suffer breaks, paralysis, and unstoppable pain.  But if you intend to treat these things, then cost saving have flown out the window with the first chemo treatment, the first surgical repair, the first 3 rounds of radiation or the first tubes in the kidneys coming out your back and your penis.  Even a correspondence-school first year CPA student* will tell you the books are cooked (as is the patient).

Bottom Line

We support the evaluation of each person’s life and problems and have an open and honest discussion as to what we can do to meet their life’s goals.  This may mean observation.  But there are options and contingency plans that must be considered with every choice.  These must be discussed and understood. The confusion about this issue is manifested and augmented by the lack of understanding of treatments, fear of cancer treatments, and predatory practices of over-zealous specialists.  The confusion is not just in patients, but most disturbingly in the Doctors themselves.

 

As to the results of the 80’s rationing of prostate care:  we saw a drop off of treatment in new prostate cancer, but a couple years later a surge in metastatic prostate cancer.  In other words, we lost curative cases for a couple years and then we’re flooded with palliative terminal management men after that.  We “observed” their suffering and death.

 

 

 

*My apologies to all CPA’s.  I love you all.  Especially my own.

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