Tell Low-Risk Prostate Cancer Patients: 'Wait for Cure'

Andrew J. Vickers, DPhil; Ian Thompson, MD


May 31, 2013

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What Is Overtreatment of Prostate Cancer?

Andrew Vickers, DPhil: Hi. I am Dr. Andrew Vickers of Memorial Sloan-Kettering Cancer Center, and I am here in San Diego at the 2013 American Urological Association (AUA) Annual Scientific Meeting. Joining me today is Dr. Ian Thompson, Director of the Cancer Therapy and Research Center of the University of Texas Health Sciences Center in San Antonio. Dr. Thompson, we hear a lot about the overtreatment of prostate cancer. How would you define overtreatment?

Ian Thompson, MD: Overtreatment, simply stated, is a patient with prostate cancer who is destined never to have problems from it, or to die from it, or have complications from it, receiving a treatment that could impose some kind of side effect.

Dr. Vickers: Obviously we can't be sure whether a man is going to have some problems from prostate cancer. How would you counter the argument that whatever the side effects of radiotherapy or surgery, they are a good deal more tolerable than advanced metastatic prostate cancer?

Dr. Thompson: That presumes that if we treat someone, they won't die from prostate cancer. We know that's not true, because most people who die from prostate cancer have high-risk disease. It also presumes that the number of people in whom we make a difference in terms of preventing death, is sufficiently large to outweigh the number of people who would receive treatment unnecessarily. It's really the balance between the two, isn't it?

It's how many people you help, as opposed to the burden of treatment. The goal is to reduce the number of people who get exposed to the side effects, and maximize the benefit.

Dr. Vickers: It's an interesting point. Everything that we do in medicine is a balance of harms and benefits. Often there is an assumption in the public that if you do something, everything will be fine, and if you don't do something, everything will be terrible.

Dr. Thompson: Well-said.

Dr. Vickers: The classic example is mammography screening. Women assume that if they get a mammogram, they won't die of breast cancer, and if they get a mammogram, they will be absolutely fine.

Dr. Thompson: It's the same across the spectrum.


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