So I know that a big conversation that you and I have had over the years is the medical
system and why they push surgery and who runs the system, but if there's so much data that
active surveillance is safe, it works, it can delay invasive and side effects, all these
issues, why do you think the medical community hasn't adapted to it considering the science
is so strong?
It might be the power of the word "cancer." The word cancer gets used a lot because it's
a common problem, but it doesn't lessen the ugliness and the scariness of that word because
most cancers are deadly and if we can ever get around to changing the name of Gleason
6 to something besides the word "cancer" maybe the doctors and patients would be more comfortable
with treating it realistically rather than emotionally.
What do you do if a man chooses active surveillance, but his entire family, because they've heard
the word cancer, is just terrified? Do you have any tips on how you can kind of discuss
those topics with them and give them some sense of security?
Sure, I mean, have them come in and talk to the doctor. It's very hard for patients to
explain, and another piece of advice I give is since the grade 6 type of prostate cancer
honestly isn't really a cancer—it doesn't metastasize, it doesn't behave like a cancer—limit
the circle of people that you start talking about it. If you want to go out and tell everybody
you have cancer, they're going to get confused and they're gonna wonder why you're not treating
it. Are you in denial? Do you have a crazy doctor? It doesn't make sense. It takes a
lot of skill to explain how something that is called cancer actually doesn't need treatment.
So, if a patient has confirmed it's Gleason 3+3=6, they've decided to go with active surveillance,
maybe they've done their own research... What would you suggest if they have a doctor who
is not in agreement?
Well, this is the beauty of our, you know, we're not—at least many of us have the discretion
without insurance to go to a different doctor. It certainly gets more difficult if you're
in an HMO and you're locked into a certain doctor, though oftentimes they'll let you
see another doctor within their system. The doctors taking care of prostate cancer are
usually surgeons or urologists and it would be very reasonable to request a second opinion
from a medical oncologist within that same system and sometimes you just have to dig
your heels in. The first book I wrote, "Invasion of the Prostate Snatchers," Ralph Blum was
advised to have surgery half a dozen times over a 15 year period and he just dug his
heels in and passed away at age 84 of nothing related to prostate cancer.
So, you know we've discussed 3+3=6 when it comes to Gleason and that being safe when
it comes to active surveillance, but what do you do—I know we've talked about it in
the staging guide for PCRI—when you have 3+4? Do you treat the system of active surveillance
any differently since it's in the Teal category? What's the difference between the two mainly?
So the thinking on what kind of prostate cancer can be safely watched has evolved since probably
2008 when active surveillance first came as an accepted methodology, and the doctors have
realized that they can expand a category of men that can be safely watched even into some
individuals that have favorable types of grade 3+4. That would be a Gleason grade 7 or an
Epstein score of 2 rather than 1, and that's a selective process. The amount of grade 4
in the biopsy is kind of the driving factor, but it certainly is a more sophisticated question,
but I think the bottom line is patients should be aware that some forms of 3+4 can also be
monitored. Historically, it's only been the 3+3s, but there are some 3+4s now that experts
agree can be safely monitored.
Thanks for watching! For more information about active surveillance, you can visit our
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cancer videos every week.