Medicine isn’t about just doing what the doctor tells you to do. Quality of life is something a doctor cannot determine. That’s a call that the patient has to make.
Let me explain by example. Prostate cancer is a difficult form of cancer, traditionally treated by removal of the prostate gland. The unfortunate side effects of that surgery are urinary incontinence, and erectile/sexual dysfunction.
A few years ago, it was discovered that some prostate cancers grow so slowly that the cancer would pose no meaningful threat to the patient. This led to an alternative approach to treatment called “watchful waiting” — basically, monitoring the growth of the cancer and doing nothing as long as the growth rate remains slow.
Now we have new research that both documents the the impact of prostate surgery and raises questions about the value of it.
A paper presents follow-up research with prostate cancer patients, some of whom had undergone prostate cancer surgery. The follow-up was conducted approximately 19.5 years after the surgery. The key findings are:
- Those who had the surgery reduced their risk of death from all causes by 5.5%. That is, 66.8% of those under watchful waiting died, as did 61.3% of those who had the surgery.
- A separate analysis determined that patients characterized as “high risk” or “low risk” at the time of the decision about surgery saw no reduction in the risk of death. The entire benefit accrued to those in the “intermediate risk” category. However, due to complicating issues, there’s a debate about how much benefit even they received.
The question for the patient (not the doctor): is the surgery worth the pain and side effects for a 5.5% decreased risk of dying?
The recommendation of the doctors presenting these results is the separation of diagnosis and treatment decisions. A specific course of treatment should not be an “automatic” follow-on to a diagnosis.
My point in writing this is that the cost/benefit analysis you have to apply to this decision is true for other diseases and treatments as well. Ultimately, you as the patient need to decide what’s right for you. And, as always, consult other independent medical professionals for second and even third opinions.
CAVEAT: As always, I’m not a doctor. I’m a researcher. My role is to make you aware of items you should know or consider in making decisions, but I’m not making the decision for you, or providing medical, legal or financial advice. Your life is yours to control and manage.
- Roger Li, MD, Ashish M. Kamat MD, and Wayne B. Duddlesten, Professor, MD Anderson Cancer Center, “AUA 2017: Radical prostatectomy versus observation for early prostate cancer: follow-up results of the prostate cancer intervention versus observation trial,” conference presentation, 2017 AUA Annual Meeting – May 12 – 16, 2017 – Boston, Massachusetts, USA