Australia’s Oncology Update recently ran this story:

Prostate cancer overtreatment ‘concerning’
By Michael Slezak

Men in the US with low-risk
prostate cancers are undergoing
comparable rates of invasive
therapy as those with high-risk
cancers, a large study has found,
raising “concern of overtreatment”.
The study of more than 120,000
people found that 75% of men
with PSA levels lower than 4.0 ng/
mL received either radical prostatectomy
(RP) or radiation therapy
(RT), even though more than half of
them harboured low-risk disease.
Moreover, “66% of men aged
between 65 and 74 years with low
risk disease and a PSA value of 4.0
ng/mL or lower received one either
RP or RT,” the authors notedin
Archives of Internal Medicine.
“These findings suggest that
many contemporary men receiving
treatment for localised
prostate cancer are unlikely to
benefit from the intervention.”
They said that the recently
publicised European results do not
accurately represent the degree of
overtreatment in the US because
“in the US patients are in general
diagnosed at earlier stages
and are more likely to receive
attempted curative therapy”.
Speaking with Oncology Update,
Professor Bruce Armstrong, from
the University of Sydney, said that
it is possible that the overtreatment
of low-risk cancers may
be even worse in Australia.
“In practice, we look as if
we have a lower level of what
you might redescribe as ‘conservative
management’ in NSW
than there was in the US,”
said Professor Armstrong.
He said the US study suggested
“that practice is somewhat
dissonant with what the
evidence suggests is appropriate
care, and what many people
think is appropriate care.”
“The key message here is
that most low-risk people – for
who there is really no positive
indications that it is acceptable
to put them on no more
than active surveillance – end up
having early curative therapy.”
In an accompanying editorial,
two researchers said that the
findings “lead to the disconcerting
realisation that an important
legacy of the PSA era might be
the overdiagnosis and overtreatment
of low-risk cancers.”

Hard to know when to treat a cancer aggressively and when to wait, don’t you think? Oncology docs are forced to do this with multiple myeloma all of the time. No reason prostate cancer shouldn’t be treated any differently.

Feel good and keep smiling! Pat

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