Which Way to Go

Christopher Lukas Health Guide
  • Most people who get a disease, especially cancer, will want to do something about it. If that’s your decision, you still have choices: surgery, radiation, seed implantation, and hormones. What follows is from the May 29th issue of Business Week:

    Even today, with a high-tech health-care system that costs the nation $2 trillion a year, there is little or no evidence that many widely used treatments and procedures actually work better than various cheaper alternatives….“The problem is that we don't know what we are doing," says Dr. David Eddy.

    Dr. David Eddy, a specialist in computer analysis of treatment options, a consultant to Blue Cross, and a highly-regarded nay-sayer when it comes to doing what most physicians say is the “right” thing to do. He has spent many years looking at whether the physicians’ traditional “wisdom” of when to treat and how to treat is actually based on statistical evidence.
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    As I’ve said in this column a number of times, the PSA test (prostate-specific antigen) became a standard diagnostic assessment for prostate cancer; based on the PSA, a doctor might urge a patient to get a biopsy. And giving the test to every man over 50 might turn out not to be a better way of finding prostate cancer than doing random biopsies.

    Of course, this goes against “common sense,” but Dr. Eddy points out that, time and again, common sense goes against statistical and medical analyses.

    In the Business Week article, Dr. Eric Klein, head of urologic oncology at the Cleveland Clinic, points out that the traditional treatments for prostate cancer have never been accurately compared, and that the field still doesn’t know if any of them will increase survival, over the long run. "How is a poor patient supposed to decide among those?" Klein says.

    As I’ve said before (and it’s emphasized in Business Week), if you go to a surgeon, he’ll probably suggest surgery; a radiation specialist – radiation. But there’s not clear evidence one way or the other!

    So, what’s a man with prostate cancer to do? Sadly, most men opt for the most aggressive treatment (often the most expensive one, too). But there’s no evidence that surgery (the aggressive treatment for prostate cancer) is better for you than radiation. In fact, except in very specific cases, there’s no evidence that any treatment is better than another; and, many would suggest, no hard evidence that any treatment will prolong your life or keep you from pain. (Again, the exceptions are the advanced cases. If your prostate cancer has spread into your bones, hormone therapy can reduce tumors and ease pain.)

    How to think long and hard about these issues is just beginning to seep into the consciousness of most patients and their families. It’s not easy. So many, many men opt for some treatment – taking the odds that one day they’ll discover hard evidence that treating prostate cancer is necessary and will save lives; and that your treatment was the best one to select.
Published On: July 28, 2006