Over treatment is the big issues thrown out there in any discussion about why men shouldn’t screen. So a couple of years ago the concept of Active Surveillance began to gain broader conceptual adoption. It’s generally considered to be a good smart option for maybe as many as half of men who are diagnosed, provided they adhere to diligent follow-up to assure that their cancer remains to be classified as “low-risk.”
The trick is, a combination of the anxiety provoking word “cancer,” coupled with little or no broadly available (eg, mainstream, generally available in MD practices) unbiased and easily understandable resources for understanding key prognostic factors (eg, the evidence-based data that helps you understand just how aggressive your cancer is) slow adoption of this important treatment option… even to the extent that a promising research trial on the subject was recently closed due to failure to accrue (recruit patients to participate).
So here is my CoC breast parallel idea #2:
Standard 2.3 Breast Conservation
A proportion of at least fifty percent (50%) of all patients diagnosed with early stage breast cancer (Stage 0, I, II) are treated with breast conserving surgery, and compliance is evaluated annually by the BPL.
POSSIBLE PARALLEL PROSTATE GUIDELINE…
A proportion of at least fifty percent (50%) of all patients diagnosed with low-risk early stage prostate cancer (PSA < 10 ng/mL, no lump felt on DRE, PSA density < 0.15, PSA velocity < 2 ng/mL/y, biopsy cores positive < 34%, and gleason score < 7) choose to undergo an Active Surveillance protocol.
See… what this does, is forces the issue of frontline pre-treatment education and support… because without that, you probably won’t be able to illustrate to at least 50% of low-risk men the costs vs. potential benefits of Active Surveillance.
Another possibly beneficial idea that might be somehow attached to this concept… could appropriate counseling at diagnosis provide a potentially monumental public health benefit if that cancer diagnosis anxiety is managed in part by taking charge of overall health re healthy lifestyle changes known to reduce risk of heart disease, diabetes, etc. in order to control low-risk cancer and reduce odds of having to progress to a more aggressive treatment modality?