UCSF's Cooperberg calls out underuse of active surveillance
in Moyad interview at the Prostate Cancer Research Institute
By Howard Wolinsky
Patients with low-risk Gleason 6 prostate “cancer” owe a mountain of gratitude to Matthew Cooperberg, MD, of the University of California, San Francisco.
Last September, he sounded the alarm about how the National Comprehensive Cancer Network guidelines had been changed to demote active surveillance (AS) from being the “preferred” approach to low-risk Gleason 6, putting AS on a par with surgery and radiation, with all the potential side effects. (Note: This is low-risk, not very low-risk.)
Cooperberg created a Twitter storm amongst urologists, and patient advocates joined in. NCCN, the chief writer of guidelines for prostate cancer, amazingly reversed itself.
Cooperberg is one of the leaders in the movement to drop the word cancer from a Gleason 6 diagnosis. Scott Eggener, MD, Cooperberg, other doctors, and I co-authored a paper on this topic that will appear soon in the Journal of Clinical Oncology.
Mark Moyad, MD, MPH, of the University of Michigan (a great interviewer, by the way. Go Blue!) recently interviewed Cooperberg at the mid-year meeting of the Prostate Cancer Research Foundation.
“If you get old enough, everybody has some cancer in the prostate, and most of this makes absolutely no difference. It causes no symptoms. It causes no threat to life. I am in a growing, vocal minority of people that think we shouldn’t even use the word cancer for some of these things because they basically have no capacity to spread or cause any harm,” Cooperberg told Moyad.
He said that about 60% of people with prostates who reach age 50 have a few cancer cells. It only goes higher as we get older. In the vast majority of us, the cancer is not life-threatening though many patients and doctors react to it that way. Most live with prostate cancer and don’t die from it,
“We put that ‘C word’ out there, the knee-jerk reaction is well, it’s a cancer. We’ve got to treat it,” Cooperberg said.
A decade ago, only about 10% of those with low-risk disease opted for active surveillance. AS has grown nationally, especially in recent years, and is followed by just under 60% of eligible patients.
This contrasts with 80% within the VA system. And it’s a long way from the 94% in Sweden.
Cooperberg said the Swedes got it right. But he noted: “It’s never going to be 100%, but that’s where they probably need to get to.”
For more from Moyad and Cooperberg, go to PCRI.
Can you help out future patients/people/men/transgender women with prostate cancer and join a webinar at 11 a.m. Eastern U.S. on April 22 for a webinar co-sponsored by a long list of support and advocacy organizations, including the leads, Active Surveillance Patients International and AnCan. (TheActiveSurveillor.com also is a sponsor—see all in flyer below:)
Please sign up for the program on the future of AS: "Your Voice in the Future of Active Surveillance," on April 22 at 11 a.m.Eastern/4 p.m. GMT. Register here: https://zoom.us/meeting/register/tJEtfuuqrzwtHNPuqzkigx65YBk8vV-teUdy
AnCan’s Virtual Support Group for AS is holding a webinar on “decisional regret” with low-risk prostate cancer at 8 p.m. Eastern April 6. No registration. Just go to the url below. The program features researcher Chris Wallace, MD, PhD, who also will answer other questions on prostate cancer.
Go to the Barniskis Room: https://www.gotomeet.me/AnswerCancer Or call +1 646 749 3129 Access Code: 222-583-973 (Barniskis Room)
The Prostate Forum of Orange County is now holding its support program for newly diagnosed prostate cancer patients at 5-7 p.m.Pacific on the second Tuesday of the month starting on April 12.
Go to: https://us02web.zoom.us/j/86164783897#success
Meeting ID: 861 6478 3897
One tap mobile +16699006833,,86164783897# US (San Jose)
Dial by your location
+1 669 900 6833 US (San Jose)
+1 253 215 8782 US (Tacoma)