On November 17th, specialists from the Netherlands, the United Kingdom, and Michigan discussed their methods for achieving very high levels of active monitoring during a webinar hosted by the Active Surveillance Coalition.
Although active surveillance has been shown to prevent prostate cancer overtreatment, most nations still neglect it. According to American models, cost-effective prostate cancer screening requires more widespread active monitoring.
Facts About Prostate Cancer
Men throughout the world get prostate cancer. With 1.3 million new cases and 358,989 deaths annually, it is the second most common male malignancy after lung cancer. The American Cancer Society predicts that there will be 268,000 cases of prostate cancer diagnosed in the United States in 2022, an increase of 20,000 cases from 2021.
Men with low-risk prostate cancer were often treated aggressively with radiation or surgery until recently (over the past decade). Both are effective in curing low-risk prostate cancer but come with substantial risks, including urinary issues and erectile dysfunction that can last a lifetime- it’s where Active Surveillance (AS) comes in.
What is Active Surveillance For Prostate Cancer?
Active surveillance is a treatment option for low-grade, slowly developing prostate cancer patients. This entails keeping an eye on prostate cancer (while still confined) until the doctor determines that more aggressive therapy is necessary to stop the illness.
Low-risk prostate cancer managed conservatively has an excellent prognosis. Clinicians and patients should have this conversation because many men with low-risk prostate cancer can avoid the harmful effects of therapy.
Sweden- The World Leader In Active Surveillance
Prostate cancer is nearly as common in Sweden as in the United States, with an incidence rate of 103 per 100,000 people Vs. 104. Although the idea of AS was first established in North America around 30 years ago, roughly a decade before Sweden adopted it, the implementation of the gentler, kinder AS method is hugely different between the two countries.
When comparing the national rates of AS adoption in males with low-risk prostate cancer, Sweden’s is 94%, whereas the U.S. average is 60%. Sweden’s stats come from its well-regarded national statistics system. Expert estimates are used for the U.S. figures.
According to Ola Bratt, MD, a prominent Swedish urological surgeon and a University of Gothenburg professor of clinical cancer epidemiology, 100% of males in various Swedish counties are on board with AS. About a third to half of the men in AS will quit the program during the first five years, and the main reasons are disease progression or the emotional toll of coping with any form of illness.
Under the microscope, the pattern of low-risk prostate cancer in men is defined as Gleason 3+3=6. The Gleason scale uses visual patterns to assess the aggressiveness of cancer. No longer is cancer diagnosed with Gleason scores below 5. More severe forms of the disease range from Gleason 7 to Gleason 10. However, less than 20% of men with a Gleason score of 3+4 take AS.
Sweden (and Canada) and the United States have different surgical cultures, which is still another point of differentiation. Like a carpenter learns to use a hammer and saw, surgeons receive specialized training to do their chosen field of work and experts refer to this as the “tool rule.”
What’s The Reason For This Difference Between The U.S. And Sweden?
Many factors contribute to the fact that the United States has a far lower adoption rate for AS than Sweden does:
- In Sweden, everyone has access to a publicly financed healthcare system, but in the U.S., men with this form of cancer are often diagnosed around age 66 and are covered by either private insurance or Medicare.
- In Sweden, urologists throughout the public health system get compensated the same whether they operate on a man or monitor his AS, reducing the financial motivation to treat the condition.
- Motivators play a significant role. Up to 80% AS acceptance has been reported by urologists working in academic practices and numerous V.A. facilities. (Despite this, several V.A. hospitals have reported extremely low acceptance rates for AS. (It’s like counting down from zero.) About 10% of Swedes have private health coverage to get in to visit doctors more quickly.
- The lowest adoption of AS in Sweden is in the capital city of Stockholm, at around 85%; nonetheless, this is still significantly higher than U.S. statistics. Urologists in Sweden do not earn financially from doing prostate cancer surgeries. This doesn’t mean that urologists in the United States prioritize profits over patient welfare, but it impacts aggregate data.
Medical experts in the U.S. and Sweden recommend that all men who have been told they have prostate cancer should seek a second opinion immediately. A decade or a single day may effectively change a person’s prostate cancer prognosis.
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