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The issue of overdiagnosis and overtreatment has recently been in the news, especially when discussing breast cancer, prostate cancer, and thyroid cancer. Meaning too much unnecessary treatment with harms, when the best approach would have been to do nothing, as studies have suggested or actually shown. Now here is an article in Medscape suggesting that rather than be quick to operate or treat, the best approach for nearly 70% of prostate cancers may be just "watching".

The U.S. Preventive Task Force, which analyzes the value of screening tests, in May 2012 recommended AGAINST routine prostate-specific antigen (PSA)-based screening for prostate cancer for all age groups. According to them, studies do not show that benefits of routine screening of asymptomatic prostate cancer and the resulting treatment outweigh the harms of treatment (e.g., surgical complications including death from surgery, erectile dysfunction, urinary incontinence, bowel dysfunction, and bladder dysfunction), or that prostate cancer treatment even reduces mortality (deaths).

They point out that: "There is convincing evidence that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer. There is also convincing evidence that a substantial percentage of men who have asymptomatic cancer detected by PSA screening have a tumor that either will not progress or will progress so slowly that it would have remained asymptomatic for the man's lifetime. The terms "overdiagnosis" or "pseudo-disease" are used to describe both situations." (NOTE: others have argued against this recommendation)

When reading the full Medscape article, it was pointed out that in the study being discussed, one person who was offered active surveillance but declined and was treated with an immediate radical prostatectomy, still died of metastatic prostate cancer. This was an example of a case where when the disease is truly aggressive, it may have spread "like a bird" throughout the body (in Dr. H. Gilbert Welch's terms in his books Overdiagnosed and Less Medicine, More Health) from the very beginning, and may be unstoppable no matter what is done.

I have also noticed reading other prostate cancer studies that a certain percentage of prostate cancers regress from the point of diagnosis (the PSA test and biopsy). In other words, researchers are finding that cancer can have different paths: regresses, stays the same, grows slowly (and can be treated when symptoms appear), or grows very quickly and is so aggressive and unstoppable that it goes through the body "like a bird". And we don't know which will be the aggressive ones when we first find them, thus the controversies over what to do: screen or not?, and treat or not?  ...continue reading "Nearly 70% of Prostate Cancers Can Just Be Watched?"