I often warn that overly aggressive mainstream screening and diagnosis of prostate cancer has led to a massive “over-treatment epidemic.” This situation occurs when prostate findings get labeled as “cancer,” but the condition doesn’t actually behave like cancer—meaning, it doesn’t invade and spread to distant parts of the body or kill the patient.
My colleague Dr. George Lundberg has often stated that we shouldn’t even call this kind of benign condition “cancer.” (George is the founding editor of Medscape, an online journal for physicians, and past editor of the Journal of the American Medical Association.)
Plus, for these low-risk cases, even the National Institutes of Health (NIH) and the American Society of Clinical Oncology (ASCO) now recommend “active surveillance”—or “watchful waiting.” Which means men suspected of having a prostate condition that may (or may not) eventually turn out to be cancerous should be monitored over time—instead of immediately being subjected to dangerous and invasive treatments with life-long side effects.
Yet, according to a new study, doctors still prescribe overly aggressive treatments in far too many cases…
New study shows not enough “watchful waiting” in low-risk cases
In a new study published in the Journal of the American Medical Association, researchers analyzed treatment plan trends for more than 160,000 men with either low-, intermediate-, or high-risk prostate cancer over a five-year period. Overall, watchful waiting was recommended for only 13 percent of men, while 42 percent received radiation therapy, and 46 percent underwent a radical prostatectomy (a procedure where the prostate gland and surrounding tissues are totally surgically removed).
Over the course of the five-year study, watchful waiting treatments rose to 42 percent—nearly tripling among men with low-risk prostate cancer.
But that figure is still far too low! Especially when you consider that most men diagnosed with prostate cancer have low-risk findings.
Plus, other countries are doing a much better job adhering to these conservative treatment guidelines. In fact, in Sweden, 74 percent of men with low-risk prostate cancer are managed with watchful waiting.
But thankfully, one group of men in the U.S. is prescribed watchful waiting over more aggressive treatments…
Veterans come out ahead this time
Another recent study analyzed treatment trends in men diagnosed with prostate cancer. This time, the study was conducted by the U.S. Department of Veterans Affairs (VA). Researchers found that 72 percent of veterans younger than 65 and 79 percent of veterans over 65 were managed conservatively with watchful waiting.
Of course, there are no financial incentives for the over-diagnosis and over-treatment of prostate cancer at the VA, unlike the first study where patients were managed in a number of different treatment settings. In other words, at the VA, no one is getting rich by performing thousands of needless prostatectomies a year.
Which brings me to my next point…
That first study I mentioned also looked at treatment plans for men diagnosed with high-risk prostate cancer. As it turns out, between 2010 and 2015, there was a 5 percent decrease in “safer” radiation therapy and a 5 percent increase in more dangerous and risky radical surgery (removal of the entire prostate gland).
That trend is going in the absolute wrong direction.
It seems to me that since doctors can no longer remove the prostates of men with low-risk “cancer,” they’re now subjecting more men with higher-risk prostate cancer to more dangerous and invasive radical surgery.
This whole business of over-treating prostate cancer reminds me of something I heard almost daily as a hospital intern…
Surgeons would often scream at interns and nurses in the operating room, “don’t just stand there, do something.” Though, when it comes to prostate cancer, evidence suggests that the better advice is, “Don’t just do something—stand there.”
But contrary to what many people think, watchful waiting doesn’t mean just doing nothing. There are still many proactive measures you can take to improve your prostate health while keeping an eye on a low-risk cancer diagnosis.
In fact, I’m putting the finishing touches on a comprehensive, science-backed prostate protocol that will address all aspects of prostate health. Including how to recognize, rein in, and even reverse prostate cancer without resorting to overly aggressive treatments.
This new online learning tool should be available to you later this month. So, stay tuned. As always, you’ll learn about it first, right here in my Daily Dispatch e-letter and my monthly Insiders’ Cures newsletter.
“Active Surveillance for Prostate Cancer Triples in US.” Medscape, 2/11/2019. (medscape.com/viewarticle/908947)
“Active Surveillance for Prostate Cancer: How to Do It Right.” 5/16/2017 (cancernetwork.com/oncology-journal/active-surveillance-prostate-cancer-how-do-it-right)