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    High-risk prostate cancer brings new challenge

    Men who would benefit from aggressive treatment don’t get it for various reasons

    National Report—Advances in the diagnosis and treatment of prostate cancer are among the great medical accomplishments of the latter part of the 20th century and beginning of the 21st. Five-year survival rates for newly diagnosed loco-regional cancer advanced from 68% in 1975-’77 to 83% in 1987-’89 to nearly 100% in 2003-’09, according to the American Cancer Society. This victory, however impressive, is incomplete.

    RELATED - High-risk prostate cancer: Video resources

    In recent years, a number of leaders in the field of prostate cancer have identified a significant cohort of men who would likely benefit from aggressive treatment of their disease but are not getting it for a variety of reasons. Peter Carroll, MD, MPH, co-director of urologic cancer at the Helen Diller Comprehensive Cancer Center and chair of the department of urology at the University of California, San Francisco, is one of these specialists.

    High-risk PCa poll

    “There are two issues. There are patients who are being over-treated. That issue is being recognized and addressed. And then there are those who are undertreated. Few seem cognizant that there is under-treatment of high-risk disease,” Dr. Carroll told Urology Times.

    “There is indeed under-treatment of high-risk disease,” said Laurence Klotz, MD, chief of the division of urology at Sunnybrook Health Sciences Center in Toronto, another specialist who is addressing this issue.

    Urology Times readers tend to agree with Dr. Carroll and Dr. Klotz. A December 2014 reader poll on the UT website asked, “Are men with higher risk prostate cancer being treated aggressively enough?” More than half (57%) said no, while 43% said yes.

    Next: 15% have high-risk disease

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