Certain events in the past week have both challenged and confirmed my once-comfortable worldview. This sort of thing seems to occur with more frequency than desired as I grow older, forcing me to reconsider some of the more rigid assumptions that have been governing my actions over the years.
But let’s not talk about the election.
It’s in the healthcare realm where I’ve been most challenged to question some of my former viewpoints. Just in the past year or so, for instance, I’ve abandoned my long-held belief that conventional medicine offers no solutions to the everyday maladies that accompany the aging process. I now take two drugs each day to lower my blood pressure and a statin to control my cholesterol. I visit my primary-care physician regularly, consult with specialists when necessary, and keep up with my COVID and flu vaccines.
My fragile ego, however, has not allowed me to completely surrender to the prevailing norms of our flawed healthcare system. I have continued to stubbornly resist certain screenings, including prostate-specific antigen (PSA) tests for my occasionally annoying prostate. And I’m happy to report that there are moments when this unconventional worldview is actually vindicated.
Just last week, JAMA Oncology published the results of a study confirming what has become clear — anecdotally, at least — to prostate cancer patients over the past several years: Aggressive treatment can create more problems than it solves.
Researchers from the Fred Hutch Cancer Center tracked the post-treatment consequences of nearly 4,000 men who had been diagnosed with prostate cancer while enrolled in two large National Cancer Institute prevention studies. Those side effects have been well documented: urinary incontinence, erectile dysfunction, radiation cystitis, radiation proctitis, as well as bladder and rectal cancers.
Reviewing Medicare claims, the team found that about one in four of those men (1,056) were treated with radiotherapy and another 655 underwent a prostatectomy. The rest were untreated.
During the 12 years after treatment, those who’d opted for radiotherapy were three times more likely than the untreated group to suffer at least one of the complications, with bladder cancer a particularly frequent occurrence. For those who had chosen a prostatectomy, the odds of experiencing harmful side effects were more than six times greater.
“Given the uncertain benefit of [prostate cancer] treatment for most patients,” lead study author Joseph Unger, PhD, concludes, “these findings highlight the importance of patient counseling before [prostate cancer] screening and treatment and provide a rationale for pursuing opportunities for cancer prevention.”
Physicians in recent years have increasingly embraced “active surveillance” when treating low-grade prostate tumors — periodic PSA tests, biopsies, and MRIs — but Unger notes that about half of their patients eventually undergo more aggressive treatment — and then cope with the consequences.
It’s that way of thinking that has kept me out of urology clinics all these years and convinced me that I may hedge my prostate bets with a regular dose of saw palmetto — despite scanty research — and perhaps a little good fortune. Meanwhile, there’s always the possibility that someone will come up with a less invasive treatment regimen that will prove effective without producing the sort of side effects so common among current prostate sufferers.
And, in fact, there may be some hope on the horizon. Researchers at the Medical University of Vienna last week released the results of a study suggesting that the key could lie in some cellular manipulation. They found that blocking a specific signaling pathway with a particular protein slowed prostate tumor growth in lab mice.
Sure, we’re talking about mice, not men, but lead study author Lukas Kenner, MD, argues that this approach not only keeps tumors at bay, but “stimulates the immune system to actively fight the cancer cells.”
That sounds like a pharmacological solution, which my former worldview would’ve quickly rejected. But I might be OK with that now — depending on the side effects.
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