Waiting on Prostate Cancer
- In this episode of “Intention to Treat,” host Rachel Gotbaum talks with patient Robert Sklamberg and Doctors Oladapo Yeku and Oliver Sartor about the option of watchful waiting in the care of men with early prostate cancer.
Lack of Diversity
Prostate cancer is a common cancer among men, and there are various treatment options available. However, there is a growing concern about the lack of representation of non-white or Caucasian patients in clinical trials for prostate cancer treatment. Dr. Oladapo Yeku raises this concern in a conversation with Dr. Oliver Sartor, a professor of medicine, urology, and radiology at the Mayo Clinic.
ProtecT Trial
The ProtecT trial is a study that investigated the effectiveness of different treatment options for prostate cancer, including active surveillance, surgery, and radiation. Dr. Sartor explains that the study shows that many men with localized prostate cancer do not need treatment and can undergo surveillance instead. However, the study did not include enough high-risk patients to conclude that surveillance is appropriate for them. Dr. Sartor discusses his approach to surveillance, which includes using MRI and genomic markers to personalize treatment plans. He emphasizes the importance of informing patients about the potential risks and benefits of different treatments and personalizing recommendations based on individual risk factors. There is controversy over whether African American men should follow the recommendations of the ProtecT trial due to their underrepresentation in the study. However, Dr. Sartor believes surveillance should be an option for those with low-risk disease.
ProtecT Results
The ProtecT study found that patients in the active surveillance arm did not do worse and nearly 80% did not require any therapy at all. However, the study did not include patients with high-risk prostate cancer or those from underrepresented groups. The study suggests that for patients with low- to intermediate-risk prostate cancer, the risk of dying from prostate cancer is the same regardless of treatment option after 8 years.
Quality of Life
The study also reports on the quality-of-life issues associated with different treatments for prostate cancer. Dr. Sartor emphasizes the importance of informing patients about these issues and involving them in the decision-making process.
Thoughtful Process
Dr. Sartor believes that PSA testing for prostate cancer is not over- or underutilized but is often misunderstood, leading to false positives and unnecessary treatment. He personally gets his PSA tested to reduce the risk of being diagnosed with advanced metastatic prostate cancer, but he emphasizes the importance of a thoughtful process and surveillance as an option for low-risk disease.
A Patient’s Experience
Robert Sklamberg, a patient with early prostate cancer, shares his experience with different treatment options. He initially considered surgery or radiation but sought a second opinion and eventually opted for active surveillance. Active surveillance involves regular checkups and testing, which can be anxiety-inducing.