Hacker News Reader

Comment by Bostonian | Hacker News Reader

Early treatment of cancer is not always better: "Surgery for early prostate cancer may not save lives. Most men just as likely to survive with limited or no treatment" https://medicine.wustl.edu/news/surgery-early-prostate-cance.... I wonder if this is true of other types of cancer.

View on HN

My dad refused treatment for his prostate cancer when he found out there was a high probability he would end up incontinent. He basically just said to my mom and his doctor “I’d rather die.” It’s been 20 years since. The tumor has completely halted its progression. Sometimes things just work out .

If you know the details, care to share them? Like Gleason score? Does he have yearly biopsies or MRIs?

I would tell you if I could, but as you might expect from the type of person who would respond this way my dad hates talking about or dealing with anything medical. I doubt he even remembers these things. He does do a yearly checkup and I’m not sure if that includes a biopsy these days (it definitely has in the past.) I basically have to catch him a day or two after his checkup in order to get any information and even then I just get the minimum amount of information possible.

A doubt - why would someone do "yearly biopsy" when you already know the tumour is cancerous? Does an annual biopsy help in some other way?

I think this is unique to prostate cancer.

As it says the average age of men getting it is 67. From experience and from data I had seen, a lot of times, the surgeons simply believe the patient is too old to have any surgery. And when they die -- e.g. family I had -- they note down the cause of death as natural causes. When you are 80-90+, practically everything gets written as natural causes.

Finally, with prostate cancer, from what we know it is not a question if a man will have prostate cancer but if the man will die before prostate cancer becomes serious or appears. That is if we doubled the age of survival to 200 years I think we would expect virtually every male at that age to have gone through prostate cancer.

That may be the case, but the other failure mode for early cancer testing is that you identify disease signals which will not turn out to be meaningful in the long run even without intervention. Iatrogenesis is a big problem with a lot of this stuff: the follow-on treatment for an epithelial precancer hit from your stomach is not harmless.

This is a reason I've read evidence based medicine people use for arguing against routine whole-body imaging.

Yes. I was touching solely the likely unique characteristics of prostate cancer. Maybe I need to clarify, but that is what I got the comment I was replying to indicated.

There was a meta-analysis published in JAMA last year which concluded that screening is unlikely to prolong lifetime for other than colorectal cancers:

https://jamanetwork.com/journals/jamainternalmedicine/articl...

> The findings of this meta-analysis suggest that colorectal cancer screening with sigmoidoscopy may extend life by approximately 3 months; lifetime gain for other screening tests appears to be unlikely or uncertain.

I am neither a physician nor qualified to comment on the article itself, but remember reading an MD commenting on it last year saying efficacy of screening was better in the 80s-90s, but with contemporary cancer medicine and improvements in surgery, we can now treat bigger cancers so early screening doesn’t necessarily prolong life expectancy.

I would not take medical advice from myself or that article though. But to your comment, I doubt it’s only prostate cancer where early screening and treatment might not yield any returns

Hmm, I notice that melanoma wasn't addressed in this study; maybe "having a good look at suspicious moles just in case" doesn't count as screening, but early detection of melanoma is considered pretty important for survival.

Yeah, again without really having any education in healthcare, I suppose that if you find a cancer before it spreads then you can operate it out. So makes sense to get suspicious moles or generally any health issues checked

It's sort of a good example of the counterpoint at the same time though: other than melanoma, skin cancer is pretty minor in general (and having it is correlated with increased life expectancy!) so combined with how rare melanoma is, I could imagine that a lot of such screening might not be associated with a net benefit.

"how rare melanoma is"

For a rare disease, I have already met too many people who have/had it. Lifetime risk is about 1:100 for white Europeans, not exactly commonplace, but not that rare either. I definitely don't ignore anything that happens on my skin, that would be a stupid way to die.

Fair, but globally it causes something like 60 thousand deaths per year (out of 55 million or so). That’s nothing to sniff at, but certainly in the realm of something you are very unlikely to die from. For comparison, cardiovascular disease kills about 17 million people per year.

> Early treatment of cancer is not always better

Sure, nothing is always better. If an intervention is statistically not better, then we will not be doing that kind of thing in the future. Better data will lead to better treatment, as will continued research.

But statistically early treatment will always end up being better. There is no theoretical situation in which having less time to systematically change an outcome will beat having more time.

Also not sure how quickly things progress in this particular case, but the article is from 2017 so that's quite a few years already.

This is almost always because of other comorbidities. People tend to get prostate cancer when older and it often (but not always) progresses slowly.. If you have other issues like obesity then you are likely to die from something else first. However, for otherwise healthy people, especially in their 60s or early 70s, it's a good idea to treat it early and aggressively. There are about 35,000 deaths from prostate cancer in the US every year; the leading cancer death after lung cancer.

This article is from 2017.

Reply on news.ycombinator.com