Tommy Chong Has Prostate Cancer, Says "Cannabis Is a Cure"

Yes, this means that some men in their 70's and older will still die of aggressive prostate cancer simply because statistically they will exist. However, the trade-off is that many more men won't die of complications from unnecessary prostate surgery and treatment.

The oft-repeated statement that one cannot reasonably distinguish the indolent prostate cancers from the aggressive ones is a myth. With basic information available on all patients in contemporary practice, prostate cancers can be risk-stratified with a good degree of accuracy. With the advent of novel blood, tissue, and imaging tests, predictive accuracy will increase further in the very near future.

The serum PSA test should not be used alone for screening; it leads to too many unnecessary biopsies. A better estimate of individual risk, including the risk of more lethal disease, can be obtained by combining the PSA test with other information such as age, family history, ethnicity and a host of novel markers being incorporated into so-called risk calculators.

The problem is that treating clinicians have historically done a poor job matching the right patients with the right treatments. These trends are starting to change, and a key advance in recent years, championed by many (including us and others at our institution), is active surveillance for men with low-risk prostate cancer.

Some writers (including the USPSTF) incorrectly conflate active surveillance with the older concept of "watchful waiting," which implies doing nothing, in effect sitting under a sword of Damocles and nervously fearing that the disease may progress to an incurable state. Active surveillance, in contrast, entails careful observation of the tumor through serial testing, with every intent of cure at the first sign of progression. To embrace active surveillance is to descend from the horns of the dilemma between avoidable overtreatment and anxious passivity in the face of an unnerving cancer diagnosis.