By: Dan Sperling, MD
If the name of Dr. Otis Brawley is not as familiar as Dr. Salk or Dr. Spock, it doesn’t surprise me. It’s not exactly a household word. However, Dr. Brawley holds an important position as the chief medical officer of the American Cancer Society. As a practicing oncologist (specialist in treating cancer) he considered a world cancer expert, and he is the author of “How We Do Harm: A Doctor Breaks Ranks About Being Sick In America.” So when Dr. Brawley speaks out, he’s worth listening to. This week, CNN gave him a platform to comment on how prostate cancer is overtreated. He issued a forceful statement that this needs to be stopped.
Dr. Brawley referred to two recent studies in the Journal of the American Medical Association (JAMA) that reveal the extent to which prostate cancer is subjected to heavy-handed treatment methods. One study examined how many men are initially put on testosterone reducing drugs—in effect, chemical castration. There is no solid evidence that the use of these medications gives a survival advantage.
The second study was of greater interest to me. It explored the common practice of treating men with early stage, low risk disease by either prostatectomy or radiation. In many cases, these patients could have gone on active surveillance as a way to delay treatments that potentially leave men with urinary, sexual and bowel dysfunction. More importantly—and this is where I truly believe our Center is doing patients a great service—I have to wonder how many of such cases would be perfect candidates for an MRI-guided focal laser ablation? As we know, early stage disease often consists of a single small focus of clinically significant cancer that can readily be destroyed without risk of side effects. Future monitoring can be done by multiparametric MRI, and no treatment windows have been closed should cancer recur.
Dr. Brawley himself points out that many prostate cancers will never progress. If they are carefully monitored, countless patients may never move to the stage where treatment is necessary. As our center and many others around the country offer advanced imaging, I want to point out that even biopsies can be avoided unless imaging reveals a suspicious area.
I’m glad that Dr. Brawley was able to broadcast his message, and I’m proud that the Sperling Prostate Center falls under its banner.