Prostate cancer is the most common form of cancer for men but it often does not present in an aggressive form of the disease. It now appears that more men with this type of prostate cancer are now, appropriately, foregoing aggressive treatment of the disease (see: More men with low-risk prostate cancer are forgoing aggressive treatment). Below is an excerpt from an ariticle on this topic:
American doctors are successfully persuading increasing numbers of men with low-risk prostate cancer to reject immediate surgery and radiation in favor of surveillance, a trend that is sparing men's sexual health without increasing their risk of death. The latest evidence that more men are postponing aggressive therapy unless their symptoms worsen came in a large study...that involved more than 125,000 veterans diagnosed with nonaggressive prostate cancer between 2005 and 2015. Researchers reviewed the former servicemen's medical records and found that in 2005, only 27 percent of men under 65 chose to forgo immediate therapy and instead signed up for “watchful waiting” or “active surveillance” to keep track of their tumors. By 2015, the situation had flipped — 72 percent rejected immediate surgery or radiation in favor of such monitoring. The data for men older than 65 was similar....
The movement away from aggressive early action has gained momentum as doctors, researchers and patients have increasingly recognized the potential harms that can occur in overtreating malignancies that may never pose a threat....[S]tudies from the United States and Europe in recent years have shown that holding off on treatment for nonaggressive prostate cancer does not result in higher death rates....[O]ne reason VA may be adhering to national guidelines at a higher rate is its lack of financial incentives for salaried physicians to recommend expensive fee-for-service procedures. In addition, VA facilities often are affiliated with academic medical centers, which are faster to adopt new approaches....Active surveillance is not for all prostate-cancer patients. It isn't recommended for men with higher-risk prostate cancer or those with genetic defects such as a BRCA mutation, which can increase the chance of having more aggressive cancer.
For me, two of the most important points being made in this article are that patients with a serious disease like cancer are well advised to seek care in academic centers where it is most likely that the most current forms of treatment will be recommended. Sometimes input from an physician in an academic academic center may be achieved when seeking a second opinion for a serious disease (see: Why One Should Always Solicit a Second Opinion for a Serious Disease). The second point in the article cited above is the observation that less aggressive treatment was commonly recommended in VA hospitals when deemed appropriate. This was because the physicians in these facilities were salaried. They thus had no financial incentive to recommend additional unnecessary treatment because they would derive no benefit from additional procedures performed for a patient.
The notion of more conservative watchful-waiting for treatment of indolent cases of prostatic has evolved over the years based on clinical observation. We are now entering an era in which genetic profiling of cancers has become commonplace. This is sometimes referred to as cancer gene profiling for response prediction. This is an important path toward better understanding of which cancers behave in a more benign way and and can thus be treated conservatively (see: Genetic Testing as a New Cancer Care Standard; Clinical Trials Also Changing; Cancer Gene Profiling for Response Prediction)