Should We Treat All Cancers? Prostate Cancer And the Case For No.


When a U.S. patient learns he has prostate cancer, of course he wants treatment. We treat all cancers, we treat them aggressively, and we either “beat them” or lose the battle trying.

But a different model of cancer is slowly emerging. A model where just because you can see the cancer doesn’t mean it’s going to do anything, and doesn’t mean you should do anything to it besides watch and wait. According to CNN: “It has been estimated that over diagnosis occurs in half of all patients with prostate cancer, perhaps 30% to 40% of those with thyroid cancer, 10% to 30% of breast cancer patients and even some with screen detected lung cancer.”

We are perhaps victims of our own technology. Cancers without symptoms or likely growth show up on ever more sensitive screening scans. These are overwhelmingly over treated.

But so what? Better to treat than not, right? Not really. Many of the treatments have serious side effects, including death. When faced with an aggressive cancer, it is well worth looking at these treatments. But when a tiny spot on the prostate results in surgery-induced incontinence and impotence, then we’ve crossed the line.

Is profit a motive?  To some extent. According to Dr. Otis Brawley, the chief medical officer of the American Cancer Society, “In the case of hormonal prostate cancer therapies, …their use consistently increased throughout the 1990s. Usage went down dramatically in 2003, when Medicare took much of the profit out of administering the treatment by reducing physician reimbursement for the drugs.”

But even after the profit was taking away, the same therapies continue to be overused. Patients are unwilling to accept the notion that just because they have cells that are cancerous does not mean they should immediately use the most drastic means necessary to remove them. And many doctors are unwilling or unable to communicate the new paradigm where having a cancer doesn’t mean you need to treat it.

Perhaps it’s time to end the “war on cancer” and come up with a new framework. But “living well with cancer” isn’t likely to get as many people out marching in support of more treatment options.


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