Why Choosing Treatment for Prostate Cancer is so Difficult

BY MARK SCHOLZ, MD

Selecting the right treatment for prostate cancer is unbelievably challenging. With other cancers, where survival is paramount, the choice is simple—do everything that can be done! But with prostate cancer, quality-of-life considerations play a much larger role, since the treatments available at this time can seriously impact the quality of your life. For some men, once their type of prostate cancer is determined, choices are somewhat easier. For example, Low-Risk prostate cancer is relatively harmless and can be safely monitored. Treatment is often deferred because the cure is worse than the disease. Decisions about treating High-Risk prostate cancer are also fairly straightforward. Most experts agree that treatment with combination therapy is appropriate. The men faced with the biggest dilemma, however, are the 60,000 to 80,000 men diagnosed every year with Intermediate-Risk prostate cancer. 

All too often, prostate cancer treatment causes some degree of impotence and incontinence.  Who wants to face sexual dysfunction unless it is absolutely required for survival? Men with Intermediate-Risk disease often feel like they are in limbo because withholding treatment for their cancer is slightly risky, but so is the treatment.  

The situation is even more confusing because if you talk to men who have already been through treatment, some seem to have weathered surgery or radiation just fine. Unfortunately, if you keep inquiring, you will come across men who feel their lives have been ruined. Men reflecting on these issues face a hard reality: choosing one of the existing treatment options can immediately destroy quality of life, while forgoing immediate treatment means having to live with the ongoing possibility that delaying treatment might someday translate into fewer years of life.

Even after careful analysis, lingering questions are inevitable, since the very best that medical science can offer is an estimate of risk. The ambiguity of these circumstances, however, leaves a lot of room for personal preference. Once a man is thoroughly educated about all his options, he, rather than the physician, is in the best position to select treatment.  After all, he is the one who will spend the rest of his life living with the consequences.

Still, there is good reason to expect things to change, hopefully in the near future. Effective ongoing research is progressing rapidly in the areas of imaging, genetics, immune therapy, and targeted pharmaceuticals. The fact that prostate cancer, in the majority of cases, is a slow-growing condition, also works to the patient’s advantage.  Every year that goes by we are one step closer to less toxic solutions. As Ralph and I always emphasize, “If waiting makes sense, time is on your side.”

*See the What’s Your Type brochure at PCRI.org for a full explanation of the difference between Low, Intermediate and High-Risk prostate cancer