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“Prostate Cancer incidence doubled,5 with low-grade cancers such as GS6 (ie, Grade Group 1) accounting for up to 70% of new diagnoses.2,3“
You’ve been diagnosed with Prostate Cancer (PCa). But your Gleason score indicates that your PCa is low-risk. What does that mean for you?
Low-risk Prostate Cancer is just like it sounds. Every choice you make involves risk. Treatment– radiation, surgery/prostatectomy, cryotherapy, etc. etc. all involve risks. Active surveillance involves risk.
The issue, in my experience as a long-term cancer survivor, is choosing the treatment plan with the lowest risks, the risks that I (you) can accept. Low-risk PCa means that if the patient does nothing, his risk of his prostate cancer causing problems, is low.
Low-risk PCa is a good start. Consider evidence-based therapies shown to reduce your risks further. Consider:
Anti-PCa Nutrition
Anti-PCa Supplementation
Anti-PCa Lifestyle therapies
I am a long-term survivor of a different type of cancer- multiple myeloma. I supplement, exercise, don’t smoke, etc. etc. I do lots of therapies shown to reduce my risk of relapse, a secondary-cancer, etc. And after more than 28 years post diagnosis, I think my anti-cancer lifestyle is working pretty well.
If you have any questions about evidence-based non-conventional therapies shown to reduce your risk of PCa, scroll down the page and write a comment or question. I will reply to you ASAP.
“Prostate-specific antigen (PSA) screening for prostate cancer (PCa) remains highly controversial, largely because it is unclear whether the primary benefits of reducing rates of metastases and cancer mortality are worth the risks of overdiagnosis, overtreatment, and potential treatment-related morbidity.
A major contributing factor to overdiagnosis and overtreatment is the designation of a particular pattern of low-grade cellular changes in the prostate as cancer, which, in our view, should not be called cancer. A simple terminology change for these lesions and removal of the cancer label would dramatically reduce overdiagnosis and overtreatment and markedly change the cost-benefit calculus of PSA screening. Although proposed previously,1,2 it never became a widespread discussion with material impact. We feel that revisiting this proposal is timely, compelling, relevant, and of utmost importance…
GS6 Histology is Highly Prevalent
After rapid and pervasive adoption of PSA-based early detection efforts in the United States, the age-adjusted PCa-specific mortality decreased by 50% and is certainly reason for celebration.3However, the unintended consequences of this pyrrhic victory adversely affected millions of men diagnosed with and treated for cancers never destined to alter their quality or quantity of life.4
PCa incidence doubled,5 with low-grade cancers such as GS6 (ie, Grade Group 1) accounting for up to 70% of new diagnoses.2,3The root of the overdiagnosis epidemic stems from > 30% of men over age 50 (more than 60% by age 80) years harbor histologic PCa, as microscopic PCa ultimately develops in nearly all prostates if a man lives long enough.4,5 Yet, only 3% of all men eventually die of PCa.3
GS6 is largely a natural, age-related histologic observation defined artefactually as a disease, not known to cause symptoms or metastases,6 but paradoxically leads to invasive monitoring or treatment. These concerns were a primary factor contributing to the US Preventive Services Task Force categorically discouraging PCa screening in 2012, specifically noting the common diagnosis and treatment of “microscopic, well-differentiated lesions…unlikely to be clinically important.”7…
Reclassifying cancer has precedent—in prostate (GS 2 through 5),29 bladder,30cervical,31 and thyroid cancers32—and has been discussed for other cancers such as breast (low-grade ductal carcinoma in situ)33 and melanoma (Fig 1).34 A commonality among many of these cancers is the high prevalence of indolent disease in the healthy population…
Advantages of Renaming GS6
Reclassification of GS6 would immediately lead to markedly fewer diagnoses of PCa; fewer men receiving radiation, surgery, and other treatments; fewer men experiencing treatment-related side effects; lower patient and family anxiety; and substantial reductions in financial burden to individuals and the health care system.35 No matter how much time a physician may spend downplaying the significance of a GS6 diagnosis or emphasizing the phrase low-risk, the words “you have cancer” have a potent psychological effect on most men and their families.
A PCa diagnosis has been associated with an increased risk of depression and suicide,36 even when low-grade, despite negligible risk of cancer-related harm. Even when a patient chooses surveillance, family or friends of patients may often find the decision to live with untreated cancer bizarre. Frustratingly, when purchasing life insurance policies, the diagnosis can lead to disqualification or considerably higher rates. Since many guidelines and policymakers advocate shared decision making,37 it is critical to consider a more patient-centric disease labeling to promote clarity and understanding, provide value, and limit undue harm…
“Overtreatment of low-grade prostate cancer (Gleason score ≤ 6) is a recognized problem today, with systematic prostate gland sampling triggered by prostate-specific antigen (PSA) measurements.1 The extent to which overtreatment is caused by fear of death resulting from cancer, fear of litigation from undertreatment, and misaligned incentives that reimburse more for treating rather than monitoring when appropriate is not known. Nevertheless, fear of death resulting from cancer likely plays some role, and removing the label “cancer” could reduce unnecessary treatment of low-grade disease.2,3
On the other hand, undertreatment of prostate cancer and a missed opportunity for cure in those who could benefit is a real risk of relabeling a cancer as noncancer. We have decided on an alternative modification of the Gleason scoring system and herein present the arguments for and against removing the label of cancer from Gleason 6 tumors. We believe that our alternative approach may help: one, ensure that patients receive the proper counseling/treatment; two, reduce the risk of overtreatment and its associated harms; and three, improve shared decision making.”
“Results: Evidence from various recent experimental, clinical and epidemiological studies indicates that select dietary micronutrients (i.e., lycopene, epigallocatechin gallate, sulforaphane, indole-3-carbinol, resveratrol, quercetin, curcumin & piperine) and zinc play a key role in prostate cancer prevention and progression and therefore hold great promise for the future overall management of prostate cancer. Conclusion: A formulation that comprises these micronutrients using the optimal, safest form and dosing should be investigated in future prostate cancer chemoprevention studies and as part of standard prostate cancer therapy…”
“Taking vitamin D supplements could slow or even reverse the progression of less aggressive, or low-grade, prostate tumors without the need for surgery or radiation, scientists say…
If a tumor is present in a prostate biopsy, a pathologist grades its aggressiveness on a scale known as the Gleason Grading System. Tumors with Gleason scores of 7 and above are considered aggressive and likely to spread, requiring surgical removal of the prostate gland (prostatectomy) or radiation therapy. In contrast, prostate tumors with Gleason scores of 6 and below are less aggressive, and in some cases may cause no symptoms or health problems for the duration of the man’s life.
In cases of low-grade prostate cancer, many urologists do not treat the disease, but instead do what’s called “active surveillance,” says Bruce Hollis, Ph.D., who is at the Medical University of South Carolina. “The cure — meaning surgery or radiation — is probably worse than the disease, so they wait a year and then do another biopsy to see where the patient stands.”
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2 comments
James Atkins says
last month
I have recently had a TURP procedure and the tissue examination came back with a 3 + 3=6 Gleason score. My PSA has ranged from 0.08 to 2.2 over the last 15 yrs, recently tested at 1.6. Should I be content with “active surveillance”? I am 76 yrs of age. Thanks for your response.
Simply asking this question indicates that you are aware of the basic issues here. As you know, I am not any sort of medical professional. My experience is that of a cancer survivor. As such, my experience is that cancer treatments often bring short, long-term and late stage side effects. Based on the diagnostic findings that you mention, my view is that active surveillance reduces your risk of side effects while keeping an eye on the health of your prostate.
