More On Watchful Waiting

Christopher Lukas Health Guide
  • A couple of weeks ago, I started to talk about the idea that doing “nothing” or next to nothing about your prostate cancer might be a worthwhile plan of action. Some people may think this is a dangerous, if not anti-medical, approach.

    In the interim, an article in the New York Times approached the subject from a different perspective, and I thought it worth the while to quote from it.

    “…while screening picks up cancers that would become deadly if left unnoticed, in many cases it also picks up tiny cancers that might have gone nowhere – people would have died with them, but not of them. Autopsies have repeatedly found that people often have such cancers, but had they been found through screening and treated, people would have thought they’d been ‘cured’.”
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    The question for oncologists, urologists and, of course, you, is whether the “tiny cancers” in your prostate are worth doing something about now, and are they worth leaving to see what happens. Or maybe not ever doing something about?

    So what if you “do something?” Then you don’t have to worry about the question of whether you’d have died from prostate cancer or with it. You’re absolutely right: in that case, you’ve extirpated the cancer, or blasted it to smithereens, or tamed it and you won’t die of it. On the other hand, maybe you’ve gone through some physical and psychological discomfort and had some rather nasty side-effects that you didn’t need to have. What then?

    This is the dilemma facing American medicine in a number of arenas these days. If you test for the disease, you may find it, and while that might mean you’ve caught a disease that is harmful, it may also mean you’ve caught a trace of a disease that wouldn’t harm the person. In this case, that person is you.

    Many men to whom I’ve related this scenario say they don’t want to hear about the dilemma; they just want the cancer out. Others recognize that we’re very good at testing in the U.S., that physicians want to test – not only to protect their patients, but to protect themselves against malpractice suits – and that, once the testing is done, they may want to go further, i.e., operate or radiate. Which means that you may want to sit tight and do that watchful waiting thing, with your physician and your family.

    Why, and why not, to go further will be the subject of several of my future columns.
Published On: July 20, 2006