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John Shoemaker

When Treating Prostate Cancer, Sometimes Less Is More

John Shoemaker's prostate cancer diagnosis launched the "data-driven" former tech executive on a months-long research project. By the time he landed in Dr. Peter Carroll's office, he knew a great deal about prostate cancer and the nation's top experts who treat it. Still, he was startled to hear Carroll's advice: Track your cancer closely, but don't treat it until necessary.

Talk about your diagnosis and your response to it.

Approximately six or seven years ago I was diagnosed with early-stage prostate cancer. Fortunately, the urologist who diagnosed me explained that with early-stage prostate cancer, there is no urgency in making a treatment decision. So being the analytical, data-driven guy that I am, my reaction was to take three to six months and do a lot of research, to learn as much as I could about the disease and the treatments that are available.

I researched every top medical center, one of the best of which was UCSF Medical Center. I set up appointments with six specialists, the last one being Peter Carroll.

Why was UCSF on your list?

The more I learned about UCSF, the more impressed I became. It is literally one of the leading institutions of its type in the world, with some of the best and brightest medical scientists. So to me, it was just logical that this is the place you would want to be if you were a patient.

Why did you pick Dr. Carroll in particular?

I researched each of the specialists that I had a consult appointment with, and found a lot of data on their performance. Peter's numbers were outstanding.

Number one, he had done these procedures thousands of times; you always want someone who has done it thousands of times. Whereas a typical surgeon would have 30, 40 or 50 percent of patients experience side effects such as sexual dysfunction or incontinence, in Peter's case, the numbers were more like 5 percent. Also the recovery rate, the bleeding — with all the signs you would use to judge the quality of the surgeon, Peter's numbers were far, far above average.

When I mentioned his name to other urologists, everyone said he was considered to be the best.

What happened at that visit?

I went through all my material and asked him what he thought — Should I do surgery, should I do radiation, what would be best? I was a young and healthy person.

His response was amazing and very encouraging to me. He said, "I have another alternative. Do neither." I said, "You mean watchful waiting?" He said, "No. The problem with watchful waiting is there is too much waiting and not enough watching."

Then he went on to explain active surveillance to me. It's a proactive program that very carefully assesses and measures, in a quantitative way, where your disease is, whether or not it's progressing. If and when it does progress, then you can make a decision as to a more intrusive type of treatment.

Another very important fact he gave me was, if a man on active surveillance requires treatment two, three, five years down the road, the success rate and the result of the treatment is equal to or better than for men who chose to have the treatment immediately.

Were you surprised to hear that from someone you'd chosen as an eminent surgeon?

It was amazing to me that a world-class surgeon would tell me that he thought I shouldn't have surgery. That really put Peter in a unique class for me. He is a very logical, objective person who truly puts his patients first.

Separate from the fact that he's a world-class medical scientist, physician and surgeon, what struck me about him when he first walked in the room was that he's a very unassuming, caring human being. That initial impression has stood up over the years that I've known him.

Was it difficult to choose no treatment?

It's important for any newly diagnosed patient to think of active surveillance as an active way of being treated. I think of myself as being treated, as having a very current, constant knowledge of the state of my disease, while at the same time not having the risks that go with invasive treatment. A patient on active surveillance should feel just as secure as a patient having surgery or some more intrusive type of approach.

I feel very confident that world-class experts at UCSF Medical Center are constantly monitoring the state of my disease, and should any change occur, they will be there in a very timely way and we'll make the right decision on what to do. Until then, I am very comfortable in my daily life.

What's daily life like on active surveillance?

Essentially, I maintain my normal quality of life, other than periodically having a few tests. Life has been very good for me.

How would you describe your experience at UCSF?

It has been outstanding. Every staff member I've interacted with has been not just extremely competent, but also friendly and personable. I could not recommend an institution more highly.

UCSF reminds me a lot of Silicon Valley, culturally. It's open and collaborative. That's the kind of environment that allows scientific advances to be made and creative new concepts to form, be nourished and grow. Active surveillance is an example of that.

Interviewed January 2013

Read More

To read an interview with Dr. Peter Carroll, featured in the video above, click here.

For more information on active surveillance, see Carroll's interview with Patient Power.

www.UCSFhealth.org/pioneeringcare

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Peter R Carroll
Dr. Peter R Carroll,
urologic cancer surgeon