HJAR Mar/Apr 2024
HEALTHCARE JOURNAL OF ARKANSAS I MAR / APR 2024 55 R. Jonathan Henderson, MD Arkansas Urology seriously enough. Alarmingly, 40 to 60% of men diagnosed with low-grade prostate cancer attend fewer appointments, reducing the efficiency and accuracy of active surveil- lance. It is therefore imperative that men on active surveillance are completely dedicated to this protocol. David Penson, MD, MPH, MMHC, a pro- fessor and chair of the urology department at Vanderbilt University Medical Center, re- ports one in five of his patients with low- grade prostate cancer will opt for surgery or radiation, even when he recommends active surveillance. I have seen this to be the case in Arkansas as well. After all, mental health and serenity are very important aspects of quality of life. It’s here that some doctors believe a change in nomenclature could create more acceptance around active surveillance and lower the fear that comes with the word “cancer.” Other doctors, including myself, believe that removing the term cancer from a low- grade prostate cancer diagnosis could lead to a greater lapse in follow-up visits during active surveillance. Anomenclature change could also potentially impact insurance cov- erage for patients undergoing active sur- veillance, creating a devastating financial burden for families across the country. As physicians and healthcare adminis- trators, it’s our ethical duty to provide the highest level of care for each and every pa- tient. That should include being honest with them about threats to their health. There is no need to stop calling low-grade prostate cancer a form of cancer. It is and always will be a diagnosis that should be taken seriously — a small rattlesnake is, nonetheless, still a rattlesnake. It’s easy for our patients to get swept up in the fear that cancer brings, especially in the world of instantaneous, and often alarming, information online. The foundation here is the doctor-patient relationship. Urologists must take the time to thoroughly educate their patients. The word “doctor”is from the Latin word for teacher. Teaching patients is our job. We have seen the death rate fromprostate cancer rise in the past decade, mostly due to decreased screening. Prostate cancer is 99% curable when caught early. The crux of the matter, though, is the detection. A man must first be detected before he can make an informed decision on active treatment versus surveillance. We lose too many men needlessly because of the lack of screening. I’m calling on you, as physicians and healthcare administrators, to continue ad- dressing low-grade cancer as cancer and prescribe active surveillance treatment plans when applicable. By downgrading low-grade prostate cancer or carcinoma’s nomencla- ture, we’re working against the foundational research and advancements of physicians putting the health of Arkansans front and center. n R.Jonathan Henderson, MD, obtained a Bachelor of Science degree at Louisiana State University in Baton Rouge in microbiology. After receiving a medical degree at LSU Medical Center in Shreveport, he completed an internship and residency in urology at LSUMC Hospital. all changed thanks to a wealth of technologi- cal advances in the past 20 years, including genetic tests, genomic tests, metagenomic tests, and radiographic imaging. Now that we can accurately diagnose and stratify men, the diagnostic path is first to determine if a man has any prostate cancer at all, and then to accurately recommend active surveillance or active treatment. William L. Dahut, MD, chief scientific offi- cer for theAmerican Cancer Society, reports familial pressure is often a driving factor for men to pursue surgery or radiation, push- ing many men into treatments they may not actually need. In my thirty years of practice, I can echo Dahut. Active surveillance allows us to avoid the side effects of aggressive treatment. Due to cancer’s slow growth, it’s entirely possible that patients with a low-grade diagnosis will never see impactful signs or symptoms in their life span, negating the need for aggres- sive treatments with lengthy recovery times. Patients undergo regular visits to their physician during active surveillance, al- lowing healthcare teams to keep a watchful eye on growth and any causes for concern. During these visits, physicians may conduct digital rectal exams, PSA (prostate-specific antigen) blood tests, an ultrasound, MRIs, and prostate biopsies to monitor the can- cer’s growth. However, it is important to note that ac- tive surveillance isn’t always without its risks. Patients have expressed feelings of anxiety around slow-growing cancers and inconve- nience tied to frequent doctor visits. Other patients do not take low-grade cancers
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