Let’s not call it prostate cancer; let’s call it–what?

Laura Newman of the Patient POV blog weighed in this week with an unusual post out of a National Institutes of Health consensus meeting on Wednesday. (Newman’s post also appeared on the  Reporting on Health blog yesterday.)

The panel decided that men who have PSAs of 10 or less and Gleason scores 6 or less “should no longer be told they have ‘cancer'” Newman writes. More than 100,000 men fit those criteria, and they are candidates not for treatment, but for “active monitoring.”

If they don’t have cancer, what exactly do they have? “The Panel declined to say what term should replace “cancer,” instead leaving it to expert pathologists and urologists  to sort out the science and meaningful language,” Newman writes. Newman doesn’t call that a cop-out, but I do. If pathologists and urologists decide what language to use, it’s likely to be some orthographic monster derived from classical Greek. I’m going to call it a prostate alert.

But this story isn’t really about language; it’s about what that language signifies. People with cancer need treatment; people without it don’t. And this story is about whether or not a prostate alert should be treated. If we don’t call it cancer, maybe more of those folks will be put on what’s called “active surveillance.”

Active surveillance is like the weather–everybody talks about it, but nobody does much about it. Newman recalls an earlier post in which she talked about a New York man who tried five doctors and finally had to go out of town to find one who was willing to follow his case with active surveillance.

Here’s the problem, Newman points out: Prostate surgery is very lucrative; active surveillance is not.

Maybe doctors need a wake-up call. Maybe they can find a way to make a living, without throwing radiation or the knife at every patient with a prostate alert. They could take a lesson from Newman, who, I’m guessing, did not get paid to write this post for her personal blog. If she can make a living while doing important work without pay, so (I’m guessing) can doctors.

– Paul Raeburn