The Latest From The American Urological Association
When I was being treated for my broken neck in 2006, my board certified spine surgeon informed me that I was in grave danger unless I had my upper cervical spine fused. The operation was apparently so complicated that he admitted that he was not qualified to perform it, his status as a board certified spine surgeon notwithstanding. Through a considerable amount of research, I ferreted out a highly qualified surgeon who I had reason to believe might shepherd my recovery sans surgery. I’ll never forget when he said to me, “The only one who will benefit from you having spine surgery will be me – financially.” As an aside, unlike my previous physician, he was qualified to perform the procedure. I wish more urologists would learn and relate the aforementioned statement to their patients.
Some fascinating news has just come out as a result of the annual meeting of the American Urological Society. I have written about the phenomenon of over treatment for prostate cancer in this country – a situation that often relegates the patient to a diminished lifestyle for a “disease” that would have potentially had no negative affect on the patient in his lifetime. A large registry in Michigan that tracks prostate cancer treatment reports that only 50% of men with low-risk prostate cancer patients who would have been eligible for active surveillance actually, take that tack and undergo radical treatment often leading to serious negative side-effects. The good news is that since 3-4 years ago, the rate of men taking the active surveillance route has doubled so the word is getting out.
The father of active surveillance is Dr. Laurence Klotz, and he is the lead investigator of long-term study of over a thousand men on active surveillance. He reports that after 10 years of monitoring these men, only 3.6% developed metastatic disease, and 1.7% have died of prostate cancer. You might think even those are bad odds, but Dr. Klotz points out that these statistics are similar to the expected mortality in those patients that get treated by radiation or surgery. To me, I’ll take my chances with the same statistics and zero side effects should I ever be diagnosed and shown to have a qualifying Gleason score!
A Gleason score of 6 definitely gives a patient the choice to take the active surveillance path, put the question was addressed, “Can a Gleason score of 3 + 3 = 6 metastasize outside the prostate gland into the seminal vesicle?” The cases of 2500 patients were reviewed to make that determination and the study revealed that NOT ONE SINGLE CASE of seminal vesicle invasion was documented when the cancer was exclusively grade 6. Also, out of 173 men with a Gleason score of 6 who had lymph nodes removed, not a single case of lymph node spread was observed. After 5 years, not a single patient had developed metastases.
The use of Statins has become a bit controversial lately. I personally have taken them for years. In Finland, a study was undertaken evaluating 6000 men to determine the difference between those taking and those not taking statins. The study revealed that Statin use reduced prostate cancer mortality by two-thirds.
A study in Europe revealed that there was an overall 60% reduction in overall mortality in men with advanced cancer taking Statins versus those who were not. Cardiovascular mortality was found to have been reduced by a similar amount.
Let’s say that you choose the surgery route. Statistically, what do you gain? A study in Denmark estimated that the length of life gained with surgery compared to the general population was 0.4 years after 10 years of observation!
Unfortunately, most of the men who are biopsied for potential prostate cancer undergo a random biopsy which at best is a hit or miss proposition with both inaccurate positives AND negatives. How much better is an MRI guided biopsy?
One of the problems with the popular random biopsy method is that it finds too many low-grade level 6 cancers leading to too much unnecessary radical type treatments. A multiparametric MRI finds high-grade disease quite efficiently and tends to miss only small, low-grade tumors. If you do need a biopsy, consider taking this modern tack.
Things are progressing in the world of prostate cancer and I have watched the stock price for Intuitive Surgical Supply, the maker of the da Vinci robotic surgical device, decline over the last couple of years. Be an active, educated patient – no one cares more about your health than you!