Can we really re-frame low-risk prostate cancer as a chronic disease?

Many readers of this web site may be interested in a video discussion on the Medscape web site between two relatively young urologists about the implications of the Prostate Outcomes Outcomes Study (PCOS), on which we commented a few months back.

The discussion between Dr. Daskivich and Dr. Resnick (one of the PCOS investigators) does not give a lot of detail about the study. Rather, it focuses on the importance of the implications of the study for urologists in talking to their patients about the risks associated with prostate cancer treatment, which in many cases may be greater than any risk presented by the disease itself — especially for older men with low risk forms of prostate cancer and a life expectancy of about a decade.

The conversation between these two younger urologists gives us a clear idea about how the “next” generation of urologists is looking at the management of prostate cancer by comparison with the prior/current generation. Doctor-patient communication is becoming a greater priority for them, as is the importance of informing the patient about the relative risks of treatment compared to the disease itself. In the long term, this can only be beneficial for newly diagnosed men, suggesting (as it does) that they are less likely to get rushed into the operating theater or the radiotherapy suite that they might have been 20 or so years ago.

Of course this does not mean that all prostate cancer that appear to be low-risk at the time of diagnosis can be monitored. As Daskovich and Resnick are careful to discuss, the real question is whether we can get better at individualizing the available information to be able to offer personalized risk assessments for individual patients, such that low-risk prostate cancer can, indeed, be framed appropriately as a chronic disorder of aging for some men but as a potentially high-risk problem for others.

3 Responses

  1. We just had a pretty heated discussion about whether Gleason 6, low-risk prostate cancer should be labeled as cancer.

    I am 59 years old, Gleason 6, currently following active surveillance. I voted “yes”, it should still be called cancer. As long as I am following the same testing routine as those who have/had higher Gleason scores, I will continue to call it cancer. I just hope that doctors can do a better job of explaining the risk of, and to, each patient throughly so the patient can make an informed decision in choosing his treatment.

  2. My husband, who is 62, was diagnosed with “slow growing” prostate cancer (adenocarcinoma) a year ago. The first biopsy resulted in one sample of cancer. We were told he would most likely die of something else before this became an issue and to have regular PSA tests. We decided to get a second opinion with our HMO urologist, who did another biopsy at the 6-month point. That biopsy resulted in three more samples of cancer. The Gleason score is still at 6, but the urologist takes a very agressive approach and wants my husband to start whatever treatment he decides on. Two oncologists told us that they did not recommend any treatment, just active surveillance. We are meeting with the oncologist at the end of the month for more clarification.

    I’d appreciate comments.

  3. Dear Mary:

    If you join our social network we can discuss your husband’s case in more detail in a less public forum. If you want to do this, in addition to his age, his Gleason score of 3 + 3 = 6, and the fact that 3/12 biopsy cores were positive for cancer, it would help us to know (a) his PSA level; (b) the volume of his prostate (if you know this); and (c) the amount of cancerous tissue in each of the three positive cores.

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