On overdiagnosis and the clinical shift to active surveillance.

We have this situation where we were over diagnosing. Half the men who were detected by PSA screening at the turn of the century were overdiagnosed, depending on how you defined overdiagnosis. And they were all getting treated. So you had this terrible problem where we were just kind of treating everybody. I think what we've learned is that, in fact, not everyone with prostate cancer needs to be treated. That PSA picks up a lot of clinically indolent prostate cancer.

On determining a patient’s treatment priorities.

The cancer control and cure piece is not quite as clear [with radiation] because you're not pulling the cancer out. So you don't have the psychological benefit of knowing what you're dealing with. And it's very hard to do surgery after radiation. So it becomes this set of options, a set of what's important to you, right? So patients may not walk in the door saying, ‘I have a preference set.’ But as you start talking to them, their preference set becomes relatively clear. And when I talk to them, I say, ‘Listen, I can tell you what I would do,’ because a lot of times they say, ‘Doc, what would you do?’ But the problem is, I can't take Dave out of Dr. Penson, right? So I have my own set of preferences.

On how emotion can override rational decision making.

But I think it's very hard to sort of turn down the emotional volume because the word ‘cancer’, any human hears that, and it scares you. Right? That goes back to what we were saying before about maybe we shouldn't be calling Gleason 6 cancer, cancer. Because there's a charge that goes with that word that freaks people out.