One of the problems with modern medical therapies is that one often
has to make a decision about them in the absence of reliable, long
term statistics about their effectiveness.
This isn't really anyone's fault. A cancer survivor who has survived
twenty years after first being diagnosed with, say, prostate cancer,
is a reflection of the success of a treatment approach taken twenty
years ago. But it doesn't tell you much about more recent approaches.
For the case of prostate cancer, there is evidence to suggest that
some therapies are effective (more so than 'watchful waiting') for
some types of cancers. For others, though, there doesn't seem to be
much of a difference between watchful waiting and active treatment, in
terms of overall disease outcomes.
And importantly, 'watchful waiting' itself is considered a 'treatment
option', and should not be thought as 'doing nothing' or a case of
treatment vs no treatment. The watchful waiting does entail active
scrutiny as to the course of the disease, with the option of taking a
more active treatment approach should conditions change. This is not
at all the same as having an undiagnosed case of prostate cancer, and
doing nothing to treat it as a result of not knowing about it.
Consider the following excerpts from the cancer.gov site regarding
Stage I (most localized) through Stage IV (most widespread) prostate
cancers (my own comments are in brackets):
http://www.nci.nih.gov/cancertopics/understanding-prostate-cancer-treatment/page7
Know Your Options: Understanding Treatment Choices for Prostate Cancer
...Your chances of being alive, and disease-free, 10 or 15 years after
diagnosis are apt to depend more on the stage and grade of your cancer
than on the choice of treatment.
[this is similar to the sentiment of your question...your odds have
more to do with the nature of the disease than your choice of
treatment, which includes 'watchful waiting' as a treatment option.
However, there are certainly profound differences to take into account
for each patient in terms of how their disease manifests itself, and
what treatments to consider]
Stage I and Stage II
...If your prostate cancer is limited to the prostate (Stages I or II)
and it is well or moderately differentiated (Gleason score 7 or
below), the 5- year outcome is considered excellent for all three
treatment options: watchful waiting, surgery, or radiation therapy.
[Again--and especially for Stage I and Stage II -- watchful waiting
can be as appropriate a choice as other treatment options. This is
especially true for older men]
...With a median age of 72 at diagnosis, many men with prostate cancer
die of a variety of other natural causes in the next 10 to 15 years.
Few men with low-grade localized disease die of prostate cancer. The
disease-specific survival rate-which excludes deaths from other
causes-is close to 90 percent. In other words, regardless of
treatment- watchful waiting, surgery, or radiation therapy-such a man
can consider his cancer a chronic disease because he is much more
likely to die of other causes than of prostate cancer.
[Re-emphasizes the same point as above -- watchful waiting can make
sense, especially for older men]
...Men with localized tumors who opt for watchful waiting, if they
live long enough, may run a greater risk of eventually developing
metastatic disease. In one series of studies, the chance of developing
metastases within 10 years was 19 percent for men with
well-differentiated tumors and 42 percent for men with moderately
differentiated tumors.
[But hold the phone...here's something to consider. The watchful
waiters may, in fact, be running more of a risk than those actively
treating their disease in terms of future odds of metastases.]
...Only one small study has directly compared watchful waiting with
radical prostatectomy, and it found no significant differences in
survival. More reliable answers should be forthcoming from ongoing
trials.
[As I mentioned earlier, there's often not a lot of reliable
statistics to compare different treatment options, especially with
treatments changing over time. But one small study, at least, doesn't
show much difference between the two options mentioned]
...Surgery or radiation therapy is chosen typically by those men whose
tumors, although apparently localized, are more extensive or poorly
differentiated (Gleason score of 8 to 10). Without aggressive therapy,
around three-quarters of such men will have developed metastatic
disease in the following 10 years, and twothirds will have died from
prostate cancer. Whether or not treatment can change these outcomes is
under study.
[For this group of men, a therapy more aggressive than watchful
waiting MAY be indicated, though again, the actual success rate of
different therapies has not yet been quantified]
Stage III
...External beam radiation therapy is often used to treat Stage III
cancers. Besides being less invasive than surgery, it is better suited
for bulky tumors. A few men have surgery, while others rely on
watchful waiting. Men whose tumors are reclassified as Stage III after
surgery (because cancer is found to have spread through the capsule or
into the lymph nodes) sometimes go on to have radiation therapy
postoperatively. Studies are in progress to evaluate this approach.
[More "studies are in progress" language, which hopefully will
elaborate on the differences between different treatment approaches]
Stage IV
...If your prostate cancer has spread to the nearby lymph nodes or to
distant parts of the body, it is called metastatic prostate cancer.
Hormonal therapy will generally improve symptoms and delay the
progress of disease for another 2 to 3 years. If just the lymph nodes
are involved, a man may use hormonal therapy to delay the progress of
prostate cancer even longer.
[An unambiguous statment that for this condition, some active therapy
makes sense, in that it can slow the progress of the disease].
==========
This seems an appropriate time to remind you of the disclaimer at the
page-bottom, about GA being no substitute for professional medical
advice.
Bottom line on the cancer.gov write-up seems to be that precise
statistics comparing treatment options (including watchful waiting)
are hard to come by. But there are bits and pieces of information to
suggest that there are indeed different outcomes in some cases, and
that active treatment approaches can make a considerable difference.
However, it does seem to come down to a judgement call. Should I get
tested? And if the tests show something, then what? No one but you
can answer those questions. But I trust the information I've provided
here will help you think through the options.
Let me know if there is anything else I can do for you on this.
All the best...and stay healthy!
pafalafa-ga
search strategy -- Google search on [ prostate cancer ] |
