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Byron Shire
March 9, 2021

Prostate cancer may be best left untreated

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My heart goes out to the author of the letter entitled Prostate Cancer who has undergone a complete prostatectomy and now regrets this course of action.

When I read Risk Savvy: How to make Good Decisions by Gerd Gigerenzer, I was shocked to discover the widespread misunderstanding and therefore misuse of the PSA testing used to diagnose prostate cancer, and that more men die WITH prostate cancer than from it. (eg, 80 per cent of men who die over 80 will have prostate cancer but will die from other causes.)

I was also shocked at the low level of training given to clinicians to interpret statistics and research findings. Professor Gigerenzer calls for the general public to become more acquainted with interpreting research ourselves, as well as much better training for our clinicians.

I couldn’t agree more. Health safety research conducted around the world has found outcomes are much improved when we play an active role in the decisions made for our health care. In fact we are more likely to survive our treatment when we do our own research and seek alternative opinions.

Yet sadly this is not encouraged in our health system, and as a society we place enormous faith in medical providers. Unfortunately countless people every year have to live with permanent injuries from the care they trusted (countless because many are not reported).

Iotragenic injury (ie, that caused by the health system) is recognised as a serious problem in our health services (one stat I have seen is 1 in 7 people who present at Emergency will experience it, and 1 in 4 who stay overnight). A recent study found that cardiology patients do better when hospital cardiologists are away on conferences (https://www.sciencedaily.com/releases/2018/03/180309095525.htm).

As a consequence of these shortcomings in our health system, we now have Choosing Wisely Australia, which provides five tips for making your health care decisions.

These tips can also be reduced to this acronym: BRAIN

* B – What are the Benefits?
* R – What are the Risks?
* A – What are the Alternatives?
* I – What does your Intuition tell you? (Malcom Gladwell writes on the human brain’s ability to filter information in split seconds in Blink: The Power of Thinking Without Thinking)
* N – What if we do Nothing?

This guideline should be given as standard procedure to anyone engaging a health provider.

Our health care system has much to offer us, particularly our emergency services, but we all need to remember this acronym whenever we are recommended treatment. We also need to always seek continuity of care, and not settle for the fragmented care public health services tend to dish up, where we see different clinicians with each visit. In the case of maternity care, mothers and babies are more likely to survive the perinatal period when they have the same carer not just through the pregnancy, but importantly during the birth and postnatal period. (http://www.cochrane.org/news/cochrane-making-difference-midwifery)

Thank you for your letter. Your message is important, and you can know it was read and taken to heart by me, and I’m sure by many others also. Legions of men, women and children walk with you. As someone who has also lived to regret some aspects of my past medical treatment, I have also come to understand the bottomless well of potential for the body to heal. Films on the mind/body connection like theconnection.tv is one such place to start. My best wishes to you.

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  1. I would choose to do nothing if diagnosed, I am 71 years old and it appears surgery can make your quality of life worse but it is a very personal descision


  2. Thanks for this excellent letter and sound advice. My dad died from stomach cancer in 2002. The doctors had recommended surgery to remove part of his stomach. When the surgeons operated they found the cancer was more advanced than anticipated, so they removed his entire stomach. He was then unable to eat. His final weeks were made worse by the surgery, which only served to hasten his demise. I avoid doctors like the plague, I live by the motto be your own doctor. Nobody knows your condition better than yourself. I agree wholeheartedly with all the advice you have given and the opinions you have shared.

  3. If only health was so simple! Complications and changes in diseases require custom tailored responses. Some prostate cancers are slow, some are aggressive. Lately, the aggressive ones are becoming more common. Knowing the difference is the aim of new tests. Stay informed. Know what is correct about your own situation.



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