To be treated, or not to be treated: Experts encourage ‘shared decision-making’ between patients, doctors
Dr. Shiv Srivastava is the co-director and scientific director of the Center for Prostate Disease Research, as well as the Judd W. Moul Basic Science Chair in the Department of Surgery at Uniformed Services University of the Health Sciences. (Courtesy photo)
THe Military Health System is promoting healthy lifestyle choices throughout Men’s Health Month, and its officials are encouraging men to take steps in preventing Prostate cancer – one of the most common diseases among men in the United States.
Although it affects one in seven men, Prostate cancer can be highly curable and easily preventable if found early. According to the National Cancer Institute, roughly 180,890 men will be diagnosed with Prostate cancer this year. Most of those men are at least 65 and do not have a life-threatening diagnosis.
Army Col. Inger Rosner, director of the Center of Prostate Disease Research at Walter Reed National Military Medical Center in Bethesda, Maryland, encourages those who could be at risk to talk to a physician regarding the benefits and possible drawbacks of screening and treatment, and advocates for shared decision-making between patients and doctors.
Until recently, men aged 50 and older were encouraged to do a prostate-specific antigen (PSA) blood test done yearly. However, the U.S. Preventive Services Task Force recommended against PSA screening in 2012, claiming it could potentially bring more harm than good to those tested. The task force concluded that some prostate cancers grow too slowly to cause a serious health threat or need treatment, and that some PSA testing can pick up on a false-positive due to other health conditions. As a result, testing can potentially lead to overdiagnosis, overtreatment or psychological and emotional distress for a patient who may not need to undergo treatment. It also said the side effects of treatment may cause more physical harm than the tumor. The American Urology Association , on the other hand, still recommends patients to discuss PSA testing with a doctor, and suggests a screening interval of two years or more in the 55 to 69 age range.
“If you talk to your urologist versus primary care doctor [about PSA testing], you may have conflicting opinions,” Rosner said. “There’s all this gray in Prostate health or Prostate cancer. The goal should be to maximize benefits and mitigate risks to each individual patient.”
Rosner said most urologists would likely follow AUA’s suggestion in screening for the cancer every two years.
Early stages of the disease typically show no clear signs of development, but the cancer can be detected through PSA testing at a primary care doctor’s office. If caught early, Prostate cancer can be managed with options such as active surveillance, radiation or surgical treatment. Local diagnosis and regional spread of the cancer have an almost 100 perfect five-year survival rate, according Dr. Shiv Srivastava, co-director of CPDR.
“We don’t necessarily need to treat all Prostate cancer,” Rosner said. “If it presents as a low-risk disease, we tend not to treat it. Not all prostate cancers are equal.”
Second only to skin cancer, Prostate cancer is the most common disease among older men. Although it is a disease than can affect younger men, it is rarely found in those under the age of 40.
Males with a family history of Prostate cancer (especially in a first-generation relative) and men of African ancestry are more likely to be at risk for developing Prostate cancer. However, gene mutations and age can also be risk factors.
“There has been tremendous process made in improving treatment and understanding the biology of prostate cancers,” Srivastava said. “Consult with a DoD physician with Prostate cancer expertise. Walter Reed National Military Medical Center-Prostate Cancer Center of Excellence is a great resource.”