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Early Detection of Prostate Cancer: Saving Lives Or Overtreating

Commentary By Dr. Willian J. Catalona


No way to know for certain that any tumor is insignificant

Some academic centers are moving toward not immediately treating prostate cancer patients who have favorable tumor features (i.e., low Gleason grade and low volume of cancer in biopsy specimens), the ones that are most likely to be cured with treatment.

In the largest study to date from the University of Toronto with some patients having long-term follow up, researchers are pleased that 60% of the patients who have elected "active monitoring" have still not been treated up to 10 years later.

However, of the approximately 40% who had evidence of progressing cancer that did require treatment and were treated with radical prostatectomy, only 42% still had organ-confined tumor.

It is concerning that of the patients who demonstrated evidence of cancer progression, nearly two-thirds of them had progressed beyond the prostate at the time of delayed treatment.

Some doctors call a cancer "overdiagnosed" and "overtreated" if it is found on the radical prostatectomy specimen to be organ confined, Gleason grade of 6 or less, and has a volume of less than 0.5cc.

They refer to it as an "insignificant" tumor, and they assume that this kind of tumor could never cause suffering or death during the patient's life span. In truth, there is no way that they could know for certain, especially in patients with a long life expectancy, because tumors can mutate and change.

The 40% figure of patients who no longer had curable disease after "active monitoring" demonstrates a doctor often cannot detect that life-threatening change in time to treat it successfully.

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