For those suffering from the lack of any really “new” news about clinical management of prostate cancer, the July issue of The ASCO Post offers some degree of relief:
- A front-page article entitled “New PSA recommendations: the debate over prostate cancer screening continues” carefully includes viewpoints from all sides this discussion, with some of the most helpful commentary coming from one of the earliest and strongest advocates for mass, population-based prostate cancer screening — Dr. David Crawford of the University of Colorado Health Sciences Center (who has now shifted his perspective considerably).
- An opinion piece by Gilbert Lawrence, MD (a radiation oncologist based in Utica, New York), and entitled “Prostate cancer management: a day late and a dollar short” offers a fierce attack on the widespread failure of the prostate cancer treatment community (regardless of specialty) to avoid over-treatment of low-risk prostate cancer.
- An extensive discussion of the data presented by Hussein et al. at the ASCO annual meeting is entitled “Continuous androgen deprivation therapy continues to be standard of care for newly diagnosed metastatic prostate cancer” (compared to intermittent ADT), but it is made very clear that this is not a point of view which is embraced by everyone who treats advanced forms of prostate cancer.
Perhaps Dr. Krongrad is right … and there really has been (almost) no new “news” in prostate cancer for the best part of 20 years. Certainly these three major issues have been with us throughout that time period!
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Dr. Lawrence’s candid editorial is fascinating. It’s comforting to know that that at least a few prostate cancer providers are willing to speak out about over-diagnosis and over-treatment.
Something that has recently been on my mind is the potential for a generational “cascade” of over-treatment. PSA screening-based awareness of risk for prostate cacner has now been around long enough to impact both fathers and sons. How many sons (and generations of sons) will have their risk factors inflated by counting a father (or older sibling or uncle) who was erroneously treated for indolent prostate cancer?
I read the opinion piece by Gilbert Lawrence and found it nearly excellent. My problem is one that I know cannot be treated in one short piece, yet I think it’s crucial to the article’s success at conveying information, or even an understandable opinion. The difficulty lies in the use of “appropriate,” in the third paragraph above the end. The word is not explicated at all. This weakens the power of Dr. Laurence’s argument considerably, since any specialist can spell it out by following his or her preferences.