Active surveillance gets a major endorsement — in Oz

Awareness of brachytherapy as a treatment for localized prostate cancer was revolutionized in the U.S. in 1996 — not by a doctor but by a patient. It is possible that a patient in Australia may just have done the same thing for active surveillance.

A year after his initial treatment in 1995, Andy Grove, then the Chairman and CEO of Intel Corp., one of the most iconic “high-tech” companies in the U.S., described — in an article in Fortune magazine — how he had decided that brachytherapy (followed by adjuvant external beam radiation therapy) was the form of treatment he would have after his diagnosis with localized prostate cancer. You can  find an archived copy of the original article on the Phoenix5 web site.

The article transformed awareness of brachytherapy, which up until that time had been practiced almost exclusively by a small cadre of dedicated physicians in Seattle and at a couple of other centers. When someone with the public visibility of an Andy Grove is willing to be that forthcoming about how and why he has come to this type of decision, it is almost inevitable that others will listen.

This morning (well, actually last night by U.S. Eastern Standard Time) John Bertrand has “gone public” in the Sydney Morning Herald about his initial decision to manage a diagnosis of localized prostate cancer with active surveillance. Of course much of the English-speaking world will have forgotten who John Bertrand is — but almost no one in Australia has — and there are some people in America, most particularly at the New York Yacht Club in Newport, Rhode Island, who never will either.

In 1983, John Bertrand skippered a yacht called Australia II — and Australia II was the first non-American yacht to win the America’s Cup since 1851. For the previous 132 years, the cup for the grand prix of ocean yacht racing had been consistently held by the New York Yacht Club. It has never returned there since.

Australia — for all that it is classified as a continent — is an island. Sailing and the sea are deeply etched in the minds of the Australian people. Winning the America’s Cup in 1983 was an historic national event, with the same level of significance as Don Larsen’s perfect game in the 1956 World Series or Roger Banister’s sub-4-minute mile in 1954. None of them had ever been done before, and at the time it was beginning to look as though all three feats might be impossible.

John Bertrand’s decision — as a national celebrity — to follow an active surveillance protocol as a way to manage his prostate cancer will “validate” active surveillance in Australia in the same way that Andy Grove’s decision to undergo brachytherapy validated what was then a relatively obscure form of treatment with limited supportive data.

Is Mr. Bertrand’s decision a good one? Who knows? We don’t have enough information. He is now 64 years of age, but all we know about his cancer is that,

Bertrand said treatment was ‘not required at the moment’ and counts himself fortunate to have detected the disease in its infancy.

What we can be quite sure of, however, is that if he does do well on active surveillance — even if only for a period of time — there will be a lot of other Australians of his generation who will say to themselves, “If it was good enough for John Bertrand, it’s good enough for me.”

One Response

  1. In an eerie coincidence, the copy of Fortune referred to above also included, after the main piece on Andy Grove’s decision, a follow-up piece on an earlier article when a man whose name I think was John Alexander had decided to folllow a “watchful waiting” path some years earlier. His decision helped me to come to my own decision.

    However, it has certainly taken a long time for any formal endorsement or support for non-treatment.

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