No one wants to hear that they or a loved one has been diagnosed with cancer. However, not all cancers are equal in their severity or mortality. Some are generally more deadly than others. And even within some cancers, different grades can be more or less worrisome. Take prostate cancer, for instance. As we have written on this blog before, the standards for surveillance and treatment of prostate cancer continue to evolve. Surprisingly, sometimes surveillance is the safest choice.
In 2011, new guidelines came out from the US Preventive Services Task Force that recommended against screening in many cases after weighing the benefits to screening against the harms, including unnecessary testing and possible harm from that testing.
These guidelines were updated again in 2017, again considering the harms associated with false positives (when the screening tools tell you there is cancer when there really isn’t).
Those harms are real, and include urinary incontinence and sexual dysfunction, while only preventing death from prostate cancer in a small number of people.
Even more recently, we’ve written more generally about this screening concept in the context of colonoscopies. Yes, as a concept, screening is good: you want a relatively non-invasive way of checking the population for cancer so that you can catch it and treat it when it’s early. But the downsides can be considerable.
Recently, a new prostate cancer study has been published evaluating various options for patients who have been diagnosed with prostate cancer. The options included surgery to remove tumors, radiation treatment, and simply monitoring. They then compared the three options over 15 years to see the whether there was any difference in deaths by prostate cancer between the three groups.
What they found was that just about everyone (97%) who had been diagnosed with prostate cancer was still alive 15 years later. The surprising discovery was that this percentage was about the same in each group – the surgery group; the radiation group; and the group that was only monitored (no treatment given).
There are a couple of caveats to these results. First, there are a small percentage of men who are considered high risk, and should probably get treatment. And, those men who were in the monitoring group did have about twice the number of patients with cancer that had spread versus the other two groups.
Considering that every year we are getting better at monitoring cancer (such as with better imaging studies and evolving genetic tests), and most men would prefer to avoid side effects to treatment such as incontinence of sexual dysfunction, it is perhaps unsurprising that in the US now, about 60% of “low-risk” prostate cancer patients are electing to simply monitor their cancer. In the context of medical malpractice litigation, this study adds to a growing understanding that it is not standard of care to jump right into treatment when a patient is diagnosed with “low risk” prostate cancer. Rather, it is the duty of the health care provider to provide informed consent to his or her patient about not only the risks and benefits of treatment, but also the possibility of no treatment (surveillance).
