“Is there an optimal management for localized prostate cancer?”

Most knowledgeable prostate cancer advocates and educators know that the answer to this question is “No.” The correct answer is that the management of localized prostate cancer needs to take account of the characteristics, objectives, and expectations of each individual patient, including his overall health and quality of life. However, it is very helpful for newly diagnosed patients, educators, and support group leaders to have access to current reviews on this topic.

A new review by Singh et al. with the above title has just been published online in a new journal called Clinical Interventions in Aging. This is an “Open Access Full Text Article.” It can be freely downloaded … so you can get a complete copy if you go to the journal web site or just click here. Support group leaders may also wish to make copies for distribution to newly diagnosed patients, and this appears to be permissable for this specific article based on the information available from the publisher.

The article appears to provide a thorough, sound, and neutral introductory review to all of the major management options (including expectant management and focal cryotherapy). It does not provide any useful information about high-intensity focused ultrasound (HIFU) — presumably because this form of treatment is not yet clinically approved in the USA.

8 Responses

  1. Excellent summary!

  2. That is helpful to an extent. But, at some point, we’ve got to be able to access information disaggregated by age and health status factors. This wouldn’t just help patients, this would be very helpful to clinicians. Sometimes you can just see that look on their faces as they try to switch gears between treating men in their 80s and men in their 40s and 50s, and know that it’s hard to switch gears between predicting outcomes for men at very different stages of life and in very different condition. How do we make good decisions for my husband based on research that describes my grandfather? It’s not helpful.

  3. Tracy:

    I don’t think anyone would disagree with you. My personal suspicion is that we are never going to be able to get at the data you are looking for without a national prostate cancer registry that collects well-defined data on all prostate cancer patients. The number of men who get diagnosed at 40 to 49 years of age is simply so small by comparison with the numbers of men in their 60s and 70s.

    In the US, between 1998 and 2002, for example, 0.5% of men were diagnosed between 35 and 44 years of age, 8.3% between 45 and 54 years of age, 26.9% between 55 and 64 years of age, and 37.0% between 65 and 74 years of age. If we assume that these percentages are still correct (at least in terms of orders of magnitude), then of the (roughly) 200,000 men who will likely be diagnosed in 2010, only 17,600 will be < 55 years of age, and about half of those (8,800) will be 50 years of age or more. By comparison, about 191,000 of the newly diagnosed will be 50 years of age or older.

  4. A population of 17k+ is not insignificant, even a 10, or 5, percent sample of 17k is far bigger than many of the randomized trial studies that get published. But, I take your point.

    What has to happen to get a national prostate cancer registry?

  5. To get a national prostate cancer registry would need a serious commitment from the NCI … and of course if we started advocating for it seriously, every other cancer advocacy community would want it for their cancer, so we are really talking about a much bigger version of SEER with a requirement to collect much more data in a prospective manner … which means a LOT of money!

  6. Is it possible to make the argument that other countries that have invested in it do a better job in treating cancer in terms of (a) survival, (b) quality of life, and (c) cost of care?

    How, in the wide, wide world of sports, are we going to move the baby boom cohort through their prime prostate cancer years if we can’t do a better job of distinguishing between aggressive and indolent cancers and find a reasonable balance between treatment efficacy and quality of life?

  7. As far as I am aware, the only nation that has a true national prostate cancer registry is Sweden. Sweden is also the nation with the highest financial commitment to nationalized health care and social security. Somehow I think that this may represent a fundamental political barrier to acceptance of the idea of a US prostate cancer registry on the basis of all except one issue. …

    The best argument, in my mind, is the potential of a national prostate cancer registry as a research model … in other words as a tool to explore the value of national registries for research purposes when linked to genetic databases for personalized medicine — with appropriate “opt-in” controls so that those who wish to “opt out” can do so without having to do anything. Remember just how politicized everything to do with health care becomes in the USA. It has nothing to do with reality and everything to do with perceptions. BUT … a de-identified registry with identifiable opt-in components MAY have legs. It would STILL need serious money!

  8. Interesting story on NPR this a.m. about myths and misconceptions related to the health care bill (which was a woefully inadequate step in the right direction in my opinion). One of the myths I found particularly interesting was the fearmongering that a registry of medical devices (like pacemakers, etc.) was actually a pretext to implant electronic tracking microchips in people.

    As someone who — on a day-in/day-out basis — analyzes state-level administrative records in support of public policy support research, I can assure you that it is wholly possible to ensure privacy and confidentiality while tracking population level data on health (and any number of other policy issues). I essentially sign away my first-born child, every tangible asset I’ve ever managed to accumulate, and the risk of a prolonged prison sentence should I misuse (accidentally or intentionally) my access to confidential records — not to mention my professional credibility.

    Privacy issues make great propaganda, that’s for sure. Ironic, huh? The risk of harm from sharing information is pretty much an abstraction, and very, very low of actual, measurable harm, while the risk of harm from poorly understood, and thus, inadequately and inappropriately treated disease is quite tangibly measurable in our daily lives.

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