The Cancer That Doctors Don't Want to Call Cancer (wsj.com) 81
A growing number of doctors are advocating to rename low-grade prostate cancer to reduce unnecessary aggressive treatments that can lead to debilitating side effects. About one-quarter of men diagnosed with prostate cancer have the lowest-risk form, yet studies show 40% opt for surgery or radiation despite recommendations for active surveillance.
The push comes amid mounting evidence that careful monitoring is effective in managing low-grade cases. A U.K. study of 1,600 men found similar 15-year mortality rates between those who chose surgery, radiation or surveillance. Some doctors oppose the change, warning it could reduce patient compliance with follow-up care.
The push comes amid mounting evidence that careful monitoring is effective in managing low-grade cases. A U.K. study of 1,600 men found similar 15-year mortality rates between those who chose surgery, radiation or surveillance. Some doctors oppose the change, warning it could reduce patient compliance with follow-up care.
"careful monitoring" (Score:5, Interesting)
Re: "careful monitoring" (Score:2)
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But, what is the criterion by which you stop monitoring and start treating?
Presumably they will go by the tumor's Gleason Score, but this requires biopsy so is invasive.
https://www.pcf.org/about-pros... [pcf.org]
Re:"careful monitoring" (Score:4, Interesting)
Also since this is the UK, you have to consider that the monitoring may not be so careful in future. We might get another Tory government that runs healthcare into the ground and tries to sell off what's left. It might even be as simple as your appointments get cancelled due to lack of staff or another pandemic.
Surgery is a one time and permanent fix. It also means that you get on the waiting list now, not when it's urgent and your life is in imminent danger.
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Surgery results in painful recovery, and a probability of incontinence and/or impotence. Watchful waiting does none of that and most men with the low grade form will die from something else in their old(er) age.
Re: "careful monitoring" (Score:3)
There's no reason to stop monitoring. At the very least, getting regular PSA blood tests to confirm whether things are stable or may have progressed. It doesn't go away, it's just slow. Until it's not. Because of the epithelial damage/repair cycle you are at risk of an additional mutation into a more aggressive cancer. Much like being a lifelong smoker - it's a known risk factor.
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There's no reason to stop monitoring. At the very least, getting regular PSA blood tests to confirm whether things are stable or may have progressed.
Don't forget poorly differentiated tumour cells may express little PSA, leading to false reassurance from a low level.
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There's no reason to stop monitoring.
You completely misread the parent's post. There absolutely is a reason to stop monitoring: If you get worse you should opt for treatment. The OP postulated the lack of a clearly defined guideline for when this transition happens. Not a point at which you just stop monitoring, but a point at which you escalate.
I like accuracy (Score:5, Insightful)
If it's a cancer, it should be called cancer. Add adjectives or train doctors to explain outcomes and probabilities better.
Re:I like accuracy (Score:5, Insightful)
Stating the obvious but we call Leukemia "Leukemia" and when someone has a form of cancer that generates some kind of growth nobody has ever said "It's not a tumor".
Well, OK, the latter is wrong but only comedically. And it's probably slightly irrelevant as it's talking about a symptom. Although the symptom is cancer as well as being caused by cancer. So... anyway.
But I've yet to hear anyone complain about Leukemia being called "Leukemia".
Also moles. You know certain types of mole are cancer right?
Nobody, as I understand it, is saying "Never describe it as a type of cancer", but they're figuring making the direct name for this kind of cancer, like Leukemia, something else so it's not the case the doctor has to use the C word and people's thoughts immediately jump to standard treatment protocols for serious cancers like, uh, Leukemia.
The problem with cancer is it really does cover a variety of conditions and actually, despite the "Call a spade a spade" consensus on Slashdot in this forum, we already do use different words to describe different forms of cancer. We're so used to it we probably don't even think about it half the time. Cancer is... well, not exactly a family of diseases, but it has a simple premise that doesn't tell us much. A cell malfunctioned and is now replicating itself with mutated DNA that stops it working the way it should.
In other words, cancer is such a generic term that complaining a form of cancer doesn't have cancer in its name is one step away from being angry that we're calling cancer "Cancer" and not "Mutation."
Being more precise means coming up with terms that better fit the specifics of the condition that resulted from that mutation.
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I mean, I'm sure these doctors explain this to them and if they stil opt to go against the treatment the doctors recommend simply because of a “scary word” then well, I don't really care that people with that mentality lower their own chances of survival. I'm young enough to might have to encounter whatever children they might produce. There's a thing to be said for natural selection.
No one is forcing them to; it's their own choice.
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Except they seldom pay out of pocket for the treatment. Even in America insurance usually pays and costs get spread around, though perhaps the insurance companies are happy as may mean more profit. Other countries it is often the tax payer who pays and there is a limited amount of tax payer money.
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Monitoring also costs money though. Do you know which is cheaper overall?
It's a valid point though, my opinion will probably depend on seeing the average prices for both.
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I don't know the answer though often monitoring is a blood test, which should be cheaper then surgery. There's always a risk with surgery as well, occasionally things go wrong.
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>Add adjectives or train doctors to explain outcomes and probabilities better.
"It's a warm, fuzzy cancer. Also cute and cuddly!"
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I like good outcomes.
If avoiding the C-word is necessary to improve medical outcomes then I'm fine with it.
Cancer is big business w/ a narrative to keep (Score:2)
Reclassifying some prostate cancer patients as not cancer is being done for political, government funding and nonprofit talking point reasons.
Funding from National Cancer Institute https://www.cancer.gov/about-n... [cancer.gov]
- Women - Breast Cancer - 2022 - $580 million - total 2016 - 2023 is $3,838.9 million
- Men - Prostate Cancer - 2022 - $280.5 million - total 2016 - 2023 is $1,717.5 million
Deaths from National Cancer Institute
- Women - Breast Cancer - 2024 - 42250 deaths - https://seer.cancer.gov/statfa... [cancer.gov]
- Men -
Re:Cancer is Cancer (Score:5, Insightful)
You would appear to be one of the people who has difficulty understanding risks and odds.
It's unfortunate, because that can lead you to making decisions that have the opposite of the outcome you desire.
Most prostate cancer progresses very slowly and is unlikely to metastasize. Very often, men with prostate cancer die of something completely unrelated. On the other hand, operating on it can cause impotence and incontinence.
If I ever get diagnosed with it, my first question to the doctor will be, "does it matter?", not a panicked question about how soon I can be scheduled for surgery
Re:Cancer is Cancer (Score:5, Interesting)
Most prostate cancer progresses very slowly and is unlikely to metastasize. Very often, men with prostate cancer die of something completely unrelated.
My father died of metastatic prostate cancer, but he was 94. At that age operation was not really a realistic option, but he lived for three years with just androgen abatement therapy. OTOH a former co-worker was diagnosed in his 50s and had his prostate removed just to be "safe".
If I ever get diagnosed with it, my first question to the doctor will be, "does it matter?"
That is the rational response, but you will still know it is there regardless of the answer, and for some people that psychological aspect is worse than the physical one. That should not be overlooked.
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Most prostate cancer progresses very slowly and is unlikely to metastasize.
It does usually progress slowly, until it doesn't, then it kills you (often painfully because it's metastasised to bone).
Very often, men with prostate cancer die of something completely unrelated.
This is what I was taught at medical school, it's also just what my dad was told 15 years ago, but the "you'll probably die of something else first" argument is just plain retarded. It's the same excuse idiots give for poor health behaviour like smoking. Medicine is getting better all the time, people aren't dying of other things so much as they used to, they are living longer and allowin
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"[T]he "you'll probably die of something else first" argument is just plain retarded. It's the same excuse idiots give for poor health behaviour like smoking."
Not exactly. The doctor saying this has empirical studies backing the conjecture that the prostate cancer is in fact very unlikely to kill you. The idiot is faced with empirical studies backing the exact opposite conjecture about his poor health behavior.
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Medicine IS getting better all the time. So conversely, a treatment with much lower risk may become available well before (if) the cancer starts advancing.
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you mean you just pulled some shit out of your ass and flung it at the wall?
That seems a rather... indelicate way of describing the treatment of prostate cancer.
Re:Cancer is Cancer (Score:5, Informative)
1) You're very likely to die of old age before this kills you.
2) You can have it treated with radiation/surgery, but there's a fairly high chance of irrepairable nerve damage that makes you permanantly incontinent (translation: you wear a diaper for the rest of your life) and you'll have permanent erectile disfunction (translation: you never have a boner again).
3) You can watch and wait, and can opt for option 2 any point in the future if things get worse.
Does that make you think differently? Cause option 3 sounds pretty damn good to me.
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Educating is not lying. You may not be old enough to understand this but when I was a child people would not even say "the C-word" out loud as if speaking the word would somehow summon it. People assumed it to be an automatic death sentence and in many cases it was. Medical science has progressed faster than public perception. Changing the name is part of that education.
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Doctors lying to their patients about the name of the condition does not change these facts.
Doctors aren't lying. We have names for things to help differentiate them in a useful way, for example have you ever heard of the term leukemia? Are you okay with that term? If so, why should you allow leukemia as a name, but not another cancer (leukemia is a form of cancer).
It makes absolute sense to not cause people to panic by using a definition they may react negatively to when they don't need.
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He would have been much better off if he just had the radical prostatectomy when he was first diagnosed and missed out on the radiation, chemo, and HRT he had to go through, all of which were utterly miserable.
Anecdotal, sure, but the "conventional wisdom" unfortun
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My understanding is that at a certain age, IIRC, 50-65, all men have prostate cancer to some degree. Looking, it is 50-60%. There's other risk factors, family members dying from it is one, being black is another. For you having had your Dad die from it, prostatectomy would be a good choice.
Re: Cancer is Cancer (Score:2)
Cancer is a blanket term that covers any one of a number of generic mutations that results in cells dividing when they're not supposed to.
Influenza is often an upper respiratory infection, but we don't call it that.
This is a question like whether Pluto is a planet. GG1 Prostate cancer doesn't meet every criteria for cancer, depending on where you draw the line. It's more like a lesion that behaves a bit like cancer on a much longer and slower scale that may mutate into an aggressive cancer because of the
Re: Cancer is Cancer (Score:1)
Another way to deny insurance (Score:5, Insightful)
"We won't approve payment for surgery, chemo, or radiation therapy since it's not cancer."
Re:Another way to deny insurance (Score:5, Funny)
US: Nah, not gonna pay for that.
UK: Here's your appointment in 76 weeks.
Canada: When would you like to schedule your euthanasia?
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The UK is lightyears better but it's not as rosy as you make it out. The target time between symptom, GP visit, diagnosis and treatment for cancers marked as "urgent" by the NHS is 28 days. Currently between 10-30% of cancer treatments are late depending on their classification due to NHS backlogs.
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Sounds better than the U.S.
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It's not. TTI (Time To Initial Treatment) average for all-type cancers is 25 days, with many aggressive cancers being closer to two weeks.
https://www.onclive.com/view/t... [onclive.com]
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Like I said, sounds better than the U.S.
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You understand that as an American it's funny to hear about waiting for an ultrasound or x-ray, right? Like those are literally available at every hospital, many outpatient, and urgent care facilities. Hell even our quacks (chiropractors) have x-ray machines. If you go to the ER with a hurt ankle you can get an x-ray immediately. Hell, you can probably get an MRI that same day (I noticed you didn't mention how long it takes for you to get an MRI).
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It's different philosophies on triaging. In most countries, it is based on medical urgency. In America, it is a combination of ability to pay and needing to profit from that expensive machine.
You can look at things like how long people live and average health to see if pushing MRI's etc actually helps compared to using them when needed.
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I agree treatments should be based on cost/benefit analysis, but how do we know the fat cats haven't tainted the scales via a hundred subtle tricks?
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And in the case of many low-grade, ow-growing prostate cancers, these treatments *shouldn't* be approved, because all you're doing then is supplying unnecessary extra income for doctors who may be doing it only out of greed.
Paywall so can't really read it (Score:1)
Here's the NIH link https://pmc.ncbi.nlm.nih.gov/a... [nih.gov]
Honestly, if it's CANCER (medically) call it cancer. It's the doctor's job to explain situation properly and to counsel the patient to appropriate care. It's not like I can walk into a hospital and say "SOMEONE SAID I HAVE CANCER GIVE ME CHEMO, BITCHES!"
We're slipping closer to idiocracy if we don't call a thing a thing because it's scary.
Self-delusion (Score:1)
Re: (Score:2)
Way to start dealing with people's health concerns, LYING TO THEM about what conditions they have, This is the idiocy that brought us "assigned male at birth", "chestfeeding" and "person with uterus”. GIVE US THE FACTS FFS.
The birthing person will be in to discuss your case with you in a couple minutes. 8^)
stepping in front of the medical envelope (Score:1)
That is, that some cell lines will be slowed or stopped in their tracks with seemingly mild treatments or severe cases, synergistically treated w
Lets call it (Score:2)
Almost cancer.
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I have a naming suggestion:
Dr: "Sorry Larry, but your prostate has been afflicted with trumpitis. It's really annoying, keeps coming back, but with luck and care it won't kill you."
Metabolic Disease (Score:2)
If you put mitochondria from a cancer cell into a noncancerous cell it becomes cancerous.
If you put healthy mitochondria into a cancerous cell it becomes noncancerous.
Damaged mitochondria go into fermentation mode for survival and everything goes to hell.
Nobody wants to admit this was discovered a hundred years ago or that the Food Pyramid causes cancer.
https://youtu.be/bKefJiYA5v0 [youtu.be]
"Eating like our ancestors" is terrible for all the people who buy off politicians.
Case study (Score:5, Informative)
The guy's wife demanded that he get it operated on. She nagged him enough and victimized herself (what will I do if you are dead?) enough that he relented.
The results? complete and permanent loss of erection, complete and permanent loss of bladder control.
I don't know if it is true, but I've heard that in matters of normal prostate cancer, men die of something else first. Note, I'm not talking about those with aggressive PC.
Re:Case study (Score:5, Insightful)
Yes that's often the case. I read once that if you did an autopsy on men who died of natural causes in old age, you'd find prostate cancer in most of them. But that wasn't what killed them.
There are many cases like the one you describe which is one reason doctors are talking about this issue.
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Well, at least she doesn't nag him anymore, could still be a net gain: a broken wanker is quiet.
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Well, at least she doesn't nag him anymore, could still be a net gain: a broken wanker is quiet.
I've always been afraid to ask, since the desire for sex doesn't go away if one isn't capable. That would have to be hell.
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One can still get an orgasm without an erection and squirting. Maybe it's not as good, but can be still be satisfying in such a way that you won't crave it for a few days. (Don't ask me how I know.)
Interesting. (Score:2)
Whilst I do prefer precise labelling, I can understand functional labelling and treatment-based classification.
If you think about it in geographical terms, you wouldn't (usually) identify a country as a subunit of the continent it is on, but may well identify a city by its State or country, even when it's not ambiguous, although not always. So there's a history of using a range of labelling techniques, humans aren't consistent.
Of course, we also differentiate between benign tumours and aggressive tumours, s
My experience, as well as others ... (Score:5, Informative)
Long time member of this forum here, but posting anonymously for obvious reasons ...
First, the article is behind a paywall, enough with the WSJ links! The people on this site are not the audience for that rag.
Second, not all cancers are the same. They are a collection of 200+ conditions that share certain characteristics (mutation, vascularization, uncontrolled growth, metastasis). But some do not kill (basal cell carcinoma, most prostate cancers, ...etc), while others are a quick death sentence.
Third, I assume the article is talking about the Gleason 3+3=6 score prostate cancer.
Here is my story:
I was diagnosed with prostate cancer age 62.
After the PSA started rising it hit 5, and a biopsy was done (not a pleasant experience).
The result was Gleason 3+4=7, which means there were some bad cancer (4) along with the type that does not tend to grow (3).
Robotic laparoscopic surgery was recommended, but like others said, the side effects include possible incontinence (wearing diapers) and impotence (no erections).
I went an had another opinion from a radiotherapy specialist, and it turns out there is no difference in outcome (for Gleason 7 in early stages) between surgery and radiation.
So it is all about weighing in the side effects of each (in my particular case).
I used the excellent Prostate Predict Tool [predict.cam], it has 15 years of data from the UK (thanks to socialized healthcare). Once you enter your data and biopsy results, it will show the odds of each side effect with each treatment as well as without. And it will show survival with and without treatment.
Radiation was my chosen treatment and there were a couple of rough weeks, but it passed, and I am back to normal.
My PSA continues to drop and I am now a year after treatment and will be monitored for 9 more years.
Joining a local prostate cancer support group is highly recommended. They share their experience, options, doctors, ..etc.
Some in my group who opted for surgery have incontinence that last for months. Some have permanent incontinence. Others have impotence usually permanently. Surgery is a hit or miss depending on anatomy, the surgeon, what he finds when you are under the knife, extent of cancer, ...etc.
A couple of people in there are Gleason 6, and are on active surveillance (which I assume this is what the article is talking about). They get their PSA checked regularly, and if it is rising, they will do multi parametric MRI or micro Ultrasound guided biopsies.
breast cancer (Score:2, Insightful)
I want to see them say that they need to rename low grade breast cancer. Bring the popcorn.
The Problem Is the Current Treatment Options (Score:5, Informative)
Prostate Cancer Survivor here. As noted in the summary, the reason that Doctors want to relabel it is because of the current aggressive treatment options. And by "current treatment options", I mean the options that insurance pays for. There are (except in certain exceptions) two: Radiation or surgery. Both of these options have major quality of life issues. Fortunately, many leading edge treatments are in the medical pipeline. Unfortunately, because of lack of long term data on treatment efficiency rates, they are not covered by normal insurance.
I was diagnosed with prostate cancer at the relatively early age of 55. Luckily, my primary care doctor started PSA testing on me when I turned 50 (which is 5 years earlier than medically recommended). After looking at all the options, I opted to get a High Intensity Focused Ultrasound (HIFU) Treatment. But I had to pay for it out of pocket, which was a $25K cost.
HIFU is not perfect and they don't claim it is. It has an 85% success rate and I was unfortunately in the 15% of people where the cancer came back and I'm under surveillance now. But I can highly recommend the procedure to anyone considering it as it was an outpatient procedure, I had no complications, still have bladder control and yes an erection. And I can be re-treated in the future. I'm already looking at some of the immune therapy options for "post treatment" cleaning up of any remaining cancer cells.
FYI, if you have prostate cancer and live on the west coast of the United States, I can highly recommend the UCLA Urology Department, which is where I got my HIFU treatment.
why do many people opt for surgery? (Score:2)
https://www.bbc.com/news/world... [bbc.com]
When people hear the 'C' word, they become scared, for good reason. If someone needs their prostate removed, how long do they have to wait in the NHS, on average?
Re: why do many people opt for surgery? (Score:2)
"the same reason that Angelina Jolie had a double mastectomy"
To get bigger tits?
Names matter (Score:2)
So yes, it's technically cancer. But the word cancer scares people.
It's kind of like Asperger's Syndrome is really part of the Autism spectrum, but giving it a different name helps patents (and loved ones) seek more appropriate treatment than they might if they just called it "low-grade Autism."
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I'd argue it is not Autism at all and you certainly shouldn't be telling high functioning kids they can become Asperger's with help. they can't. they can improve but not make that leap. Besides, there is no genetic link for autism but there is correlation on Aspergers. Eventually the details will be figured out but until then we are generalizing two groups-- one which has funding and one that does not. When we find the DNA that'll settle it; if we even look since Autism is proven to not be genetic so why e
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You might need to argue with the DSM, which classifies Asperger's and Autism under Autism Spectrum Disorder. https://www.medicalnewstoday.c... [medicalnewstoday.com]
Why not (Score:2)
call it Gemini ? (Not quite yet Cancer)