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

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