Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Watchful waiting is underutilized for most men with prostate cancer

John Schumann, MD
Conditions
October 8, 2010
Share
Tweet
Share

NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.

If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”

Very telling.

The thrust of the article and the subsequent blog post is that men diagnosed with prostate cancer that have PSA values of less than 4.0 nanograms per milliliter of blood (“ng/mL”, the standard measurement) usually opt for treatment of their cancer, even though their cancer may not necessarily harm them.

What’s that, you say? How can cancer not harm someone?

This is an extremely vexing issue in the world of medicine, so it bears exploring.

Most importantly, it’s important to understand that “cancer” is not one disease. This is perhaps the most commonly repeated media misconception, as when talking heads go to commercial break and say, “Coming up next: Scientists at Yada Yada U. claim that they have the cure for cancer. Is it true? Stay tuned to find out.”

 

Cancer is a process, in which the genetically-programmed regulation of normal cells goes haywire and leads to unfettered replication. It can occur in many different cell types, in almost any of your body’s organs. As such, there are numerous cellular and molecular targets of potential medicines, so a claim that one thing can cure [all] cancer is ludicrous on its face.

It so happens that on the spectrum of cancers, prostate cancer is the most commonly occurring one in men. That said, its fatality rate, the rate at which death is caused by the cancer, is very low.

How low?

Well, the five-year survival of diagnosed prostate cancer is one hundred percent. That means if you’re diagnosed with prostate cancer today, you’re essentially guaranteed to be around in five years. The ten-year survival is 91%. Not perfect, but not bad. I’d take those odds.

Contrast that to cancer of the pancreas. A much less common occurring cancer, but much more fatal: The five-year survival is 5.6%.

So what’s the point of all this?

I was taught an aphorism in medical school: “Most men die with prostate cancer, not because of it.” At autopsy, old men frequently had cancer in their prostates–but died from other, unrelated causes.

The point becomes think twice; think even four times about treating low grade prostate cancer. The treatments are invasive. The surgery usually leaves men with incontinence (leakage of urine) and impotence (inability to achieve erections). The problem is that the non-surgical option, radiation, causes the same harms at comparable rates.

ADVERTISEMENT

Men are offered this bargain, and based on the article mentioned at the outset, it seems that they choose treatment over non-treatment (“watchful waiting”). For most of us, just hearing the word cancer is enough to make us terrified and want some kind of treatment, no matter how invasive. We’re a culture of doing something.

If you go over to the Shots blog linked at the top, you can read the comments below the post. Many are along the lines of “I’m grateful to have been diagnosed and treated early; my incontinence is mostly gone, or an inconvenience that I can live with, so this is article is a disservice to men everywhere, etc.”

I have no qualms with men having a choice about whether they want treatment or not. But those commenters suffer from what we call “treatment bias.” They want to justify their decision to undergo treatment, which is fine; I’m merely saying that treatment of “garden variety” prostate cancer is neither mandatory, nor in every man’s best interest.

I will agree, however, that there exists an aggressive subtype of prostate cancer that metastasizes early and does have the power to harm and ultimately kill.

And that’s what we need to figure out. Who (and how often) has this aggressive subtype that warrants more urgent treatment? Riches and prizes will certainly flow to those who solve this one.

But for the majority of men diagnosed with prostate cancer, watchful waiting (i.e. doing no harm) is a viable, underutilized option. This vexing issue is one of many examples of a Pandora’s box that our technologies (e.g. the PSA test) burden us with.

John Schumann is an internal medicine physician at the University of Chicago who blogs at GlassHospital.

Submit a guest post and be heard.

Prev

When parents should be concerned about a lump on their child

October 8, 2010 Kevin 1
…
Next

Server upgraded, apologies for lost overnight comments

October 9, 2010 Kevin 0
…

Tagged as: Oncology/Hematology, Patients

Post navigation

< Previous Post
When parents should be concerned about a lump on their child
Next Post >
Server upgraded, apologies for lost overnight comments

ADVERTISEMENT

More by John Schumann, MD

  • Doctors as the gatekeepers of marijuana is a race to the bottom

    John Schumann, MD
  • Rallying at the end of life

    John Schumann, MD
  • The evolution of a hospital admission

    John Schumann, MD

More in Conditions

  • How President Biden’s cognitive health shapes political and legal trust

    Muhamad Aly Rifai, MD
  • The emotional first responders of aesthetic medicine

    Sarah White, APRN
  • Why testosterone matters more than you think in women’s health

    Andrea Caamano, MD
  • How veteran health care is being transformed by tech and teamwork

    Deborah Lafer Scher
  • What Elon Musk and Diddy reveal about the price of power

    Osmund Agbo, MD
  • Understanding depression beyond biology: the power of therapy and meaning

    Maire Daugharty, MD
  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...