In December of 2011 the National Institute of Health (NIH) released a draft State-of-the-Science Conference Statement. The focus of the study was on PSA-based screening which has identified many men with low-risk prostate cancer. Over the past decade active surveillance has emerged as a viable option for men with low-risk prostate cancer. This represents approximately 100,000 men diagnosed in the United States each year. Despite the very favorable prognosis of low-risk prostate cancer, many men with low-risk disease continue to opt for or are only offered treatments such as radical prostatectomy or radiation therapy which can lead to side-effects such as impotence and incontinence in a substantial number of men. The NIH draft statement suggests that strong consideration be given to removing the anxiety-provoking term “cancer” for low-risk prostate cancer. This means that men who today would be diagnosed with low-risk prostate cancer would no longer be considered cancer survivors and would likely automatically undergo either Active Surveillance or Watchful Waiting (depending on age and other co-morbidities). This could also cut prostate cancer incidence in half.
Prior to this the U.S. Preventive Services Task Force (USPSTF) released a draft position statement based on their review of several large prostate cancer screening trials. The USPSTF, following a standardized protocol, developed an analytic framework to explore key questions such as: the effectiveness of PSA-based screening in decreasing prostate cancer–specific or all-cause mortality; the harms that may be set forth as a result of PSA-based screening; the benefits of treating early-stage or screening-detected prostate cancer; and the harms of treating of early-stage or screening-detected prostate cancer. Recommendations were based on 2 fair-quality and 3 poor-quality randomized trials of PSA-based screening. While study contamination makes accurate evaluation of PSA as a tool to find cancer early and thereby treat it more effectively almost impossible, these studies clearly demonstrate the devastating impact of overtreatment on men diagnosed with prostate cancer. This has resulted in the USPSTF draft recommending that PSA-based screening be ranked a D.
Other important studies indicate that under-treatment of aggressive cancer too is a major issue, even further reducing the effectiveness of early intervention. My question is – as patient advocates how and why are we unable to read between the lines? Wouldn’t it make sense to redirect attention to advocate for better patient education and decision support to prevent or reduce over-treatment, under-treatment, and mismatched treatment? Or I guess we could ignore these issues and focus on sending as many men as possible into a confusing and potentially devastating situation that might do little to support longevity or protect his quality of life…
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