Are Men With Localized Prostate Cancer Being Overtreated?

The other day I'm talking to a friend whose dad, at 75, elected to have da Vinci robotic surgery for localized PC. I couldn't believe his dad had done anything. He had a Gleason score of 6, which is not life threatening at all and indicates a super slow growing cancer, especially at his age:  Why go through the surgery and risk the side effects of therapy?  Which is not fun.

Because, he explained, "my Dad wanted it out."

Get the cancer out at all costs.  Well, that's the first problem.  Most guys don't understand not everyone needs to get rid of prostate cancer, that most ALL men get  PC if they live long enough, and that about 50% of it is so slow growing it's not a risk to their life, according to research from scientists at the University of Michigan (The Prostate Cancer Quandary, Wall Street Journal, June 28, 2010).

Half of all prostate cancer is not a threat.  But guys are freaked out by having it.  Yet doctors are not educating them on watchful waiting as a smarter  option.  Smarter because the side effects of treatment are rough, and likely lifelong -- and completely unnecessary for many guys.

Here's the second problem and why we may see this trend of overtreatment continue in the near future:

Providers are making HUGE investments in developing and implementing proton therapy (a half billion dollars or so a set up), IGRT and other amazing technologies ... but who will pay for this investment if the vast majority of senior guys is watching the cancer? My radiation oncologist talked his hospital's cancer center into making the biggest investment they ever made a piece of equipment in the IGRT (Image Guided Radiation Therapy) machine -- you think he's talking over age 75 patients into doing nothing? Into watchful waiting?  I liked my radiologist, but let's be real. Hospitals with massively expensive therapy investments need patients (and insurers) to pay the bills -- or Medicare to reimburse.