BY RICHARD LAM, MD
ACTIVE SURVEILLANCE is growing acceptance in professional societies. AUA, ASCO (NCCN) have recommended in their guidelines to physicians – LOW RISK prostate cancer patients → consider using active surveIllance. Then why is ACTIVE SURVEILLANCE a slow adoption for some physicians and patients?
Well, there are many reasons, one reason is when a patient is told they have cancer, their gut reaction is “I want it out, I want to get rid of it. Cancer = Bad.” Immediately the patient wants treatment, his significant other wants treatment. Additionally, it’s easy for the doctor to go along with treatment. After all this is cancer and it is OK to treat. A doctor usually cannot be faulted or sued for curing someone, even though he helped cause incontinence and impotence.
But potentially if the patient did not get treatment and for some reason, during active surveillance things got bad (consult a prostate cancer expert), that doctor would be afraid to get sued. Perhaps, there is a liability issue or physicians have been taught over the years, to treat cancer, patients want to get treatment, regardless of the potential life altering side effects. It does take time to educate patients, spouses and doctors – there is such a thing as “good” cancer. A cancer that never causes problems (GLEASON 6 – THE UNCANCER > https://www.verywell.com/the-uncancer-2782286
As a medical oncologist and prostate cancer specialist, I feel very confident in my ability to educate the patient, without any biases. As a confidant helping them make a decision for their best welfare. Some patients do need treatment and some don’t – even for patients that need treatment, I feel it’s very important that a medical oncologist be the confidant and quarterback for prostate cancer management.