96: Thyroid and Prostate Cancer — Surgery Outcomes Sometimes Worse Than No Surgery — Weighing Risks and Outcomes with Dr. Allen Ho

Allen S. Ho MD is Associate Professor of Surgery, Director of the Head and Neck Cancer Program, and Co-Director of the Thyroid Cancer Program at Cedars-Sinai Medical Center. As a fellowship-trained head and neck surgeon. His practice focuses on the treatment of head and neck tumors, including HPV(+) throat cancers and thyroid malignancies. He leads the multidisciplinary Cedars-Sinai Head and Neck Tumor Board, which provides consensus management options for complex, advanced cases. Dr. Ho’s research interests are highly integrated into his clinical practice. His current efforts lie in cancer proteomics, HPV(+) oropharyngeal cancer pathogenesis, and thyroid cancer molecular assays. Dr. Ho has published as lead author in journals that include Nature Genetics, JCO, JAMA Oncology, and Thyroid, and is Editor of the textbook Multidisciplinary Care of the Head and Neck Cancer Patient (Springer 2018). Dr. Ho serves on national committees within the AHNS and ATA, and leads a national trial on thyroid cancer active surveillance (ClinicalTrials.gov ID: NCT02609685). He maintains expertise in transoral robotic surgery (TORS), minimally invasive thyroidectomy approaches, and nerve preservation techniques. Dr. Ho’s overarching aim is to partner with patients to optimize treatment and provide compassionate, exceptional care.

In this interview — a discussion about Dr. Ho’s research; Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review. Topics include:

prostate and thyroid cancer parallels

prostate cancer and practical acceptance of active surveillance

randomized and followed patients through true active surveillance

overall survival, comparing thyroid and prostrate cancer

tolerance of risk

Older versus younger patient priorities

Younger patient  thought process

Weighing quality of life and risk

Hypothyroidism, parathyroidism, laryngeal nerve risk in thyroidectomy… asymptomatic patients being made symptomatic due to treatment

Physicians have embraced active surveillance for prostate cancer more than thyroid

The patient leans on physician for guidance

The Finland study: 17M in U.S. have thyroid cancer

Extrapolation — Patients who die of other conditions, in autopsies very small thyroid cancers found in 36% of patients

A lot of small cancers that need not be diagnosed

The physicians perspective and influencing the active surveillance decision

Shared decision making process

Terminology… some people choose active surveillance even when nodule is greater than 2cm

Jury is still out on what is considered safe size

Size and lymph node spread is still being defined

Moving away from Gleason system

Some cancers are aggressive

Some cancers are slow and not lethal

Incidental cancers

The word cancer or the c word… and shifting away from fear

Radiology guidelines

The Cedars Sinai active surveillance program

50% of patients who are offered surveillance accept it… which mirrors Japan

Alienation of active surveillance patients

Anxious, calm, and risk and prioritize risks of surgery 

Thyroid cancer tends to strike younger patients.  Prostrate cancer tends to be older.

Prostrate cancer may not improve survival

Surgery in thyroid versus prostate is safer

Radiation ad toxicity

NOTES

Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

89: Your Patient ‘Type’ May Determine Your Thyroid Cancer Treatment → Dr. Michael Tuttle from Sloan Kettering

77: Broadway Performer Says No to Thyroid Cancer Surgery → Surveillance Instead

87: Is There a Stigma to Choosing Active Surveillance? → Dr. Louise Davies from The Dartmouth Institute

Vigilancia activa en el tratamiento del microcarcinoma de tiroides.

Dr. Allen Ho