More from the AUA in San Francisco

The most interesting thing about the educational process at the AUA this year is the increasing appreciation of the complexity of the decision-making processes required by patients and their doctors as regards prostate cancer risk and management.

After sitting through multiple sessions and discussions at which few really “new” data have been presented, your correspondent is struck by the fact that, for all the increase in data and information that is meant to be able to help a doctor and his patient make good decisions about treatment, what has actually happened over the past decade is that we may have just made the decisions more difficult for most patients and their doctors — with little actual long-term benefit.

Many in the urology community seem, themselves, to be at a loss as to how best to help their patients — particularly those diagnosed with low risk disease. Although we have an expanding range of therapeutic options for the treatment of early stage prostate cancer, knowing which form of management is going to be most appropriate and effective for an individual patient is an almost impossible task. And for those who decide that active surveillance is a reasonable means of managing their condition, there are significant differences of opinion about how to make the best possible decision to come off active surveillance and move to treatment when this is really necessary.

In a state-of-the-art lecture, later today, Dr. Eric Klein of the Cleveland Clinic will present the hypothesis that “Prostate cancer may be an infectious disease.” We have to say that this is probably not the best title for this lecture — catchy though it is. What Dr. Klein will actually do is review available data suggesting that the XMRV retrovirus may act as a trigger for development of certain types of prostate cancer in men who harbor this virus. As yet there is no clear evidence that the XMRV virus either triggers the development of prostate cancer or causes this form of cancer. And while it does appear possible that XMRV infection may lead to the development of prostate cancer in some men, it seems highly unlikely to your correspondent that the presence of XMRV is the only reason for development of prostate cancer. In other words, prostate cancer is still going to be found in men who have never been infected by XMRV.

From a patient point of view, we are at a point in time where there is enormous development in our technical skills to diagnose and treat patients with prostate cancer, but what we also need is some real movement in the area of application of all of this development in the best interests of the patient. Knowing what we can do is not even close to helping an individual patient and his doctors to know what they should do in the best interests of that patient.

One Response

  1. Maybe one of the many doctors I consulted was right when he said that he never recommended second opinions, as it only confused the patient.

    Since there is no evidence that one form of treatment, or non-treatment, produces superior results for the majority of diagnosed men, maybe these men should just go with the first recommendation they get?

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