Of course it can be done, but will it? I don't think so, not while there are so many millions of dollars in play in creating anxiety about every facet of prostate cancer, from PSA testing/screening to the inappropriate tests and scans ordered, to the lack of clear indications of outcomes, to unneccesary adjuvant treatments (or should I say adjuvant treatments that have no demonstrable value … the list goes on. This anxiety drives men like beaters at a pheasant shoot, right into early treatment.

In the midst of all this gloomy outlook there is the faintest glimmer of light. I have personally experienced the change in attitude to what was called, so inappropriately, watchful waiting and which is now commonly referred to as active surveillance.

Thirteen years ago it was clear that the general view was that only fools and lunatics would consider such a step. The lunacy element has been removed now and men who follow this path, and the doctors who support that decisio,n are merely regarded as foolish. Perhaps as more time goes by and more studies are published, even that appellation might be removed.

Patient initiated ADT? Ya gotta wonder who's been castrated here (sorry if this is in bad taste). Doctors should not perform treatments just because patients insist on it. I wonder if the scourge that is direct-to-consumer advertising has played a role in this. Patients see a drug on TV and demand that the doctor given it to them.

This is a very important article because the findings can be useful in other PC settings. We know that patients have HT, which is of questionable benefit and very unpleasant, because they're anxious. Also, patients with low-grade PC forgo active surveillance or convert to treatment because they're anxious.

The solution is to treat the anxiety. It can be done. I also think that if more men did not rush into treatment (which is common in other countries), some of the anxiety related to PC would abate. In the US our inclination is to always do something. So it's understandable that no guy wants to be the odd man out who holds off. I think we need a cultural shift. Abolishing payments to docs based on the number of procedures they do would also help.

PS: I'm not sure what the implications of this study are for younger patients.