Did I Actually Hear You Say “Just-Cut-It-Out?”

BY RALPH BLUM

On New Year’s Day, I heard from Max, an old friend who, to my surprise, announced, “I’m scheduled for surgery. I just don’t want to have to think about prostate cancer ever again.” His PSA and Gleason score put him at a low-risk level, and the last time we had talked he was planning to monitor the cancer for a while before making any treatment decision. So what had changed his mind?

I’ve said it before and I’m saying it again, because it doesn’t seem to sink in. I have interviewed hundreds of men newly diagnosed with prostate cancer, and an astonishing number of them seem to have failed to make this vital connection: When your family doctor refers you to the urologist, he is sending you to a surgeon.

It’s a feverish sense of frustration that has driven me to revisit this subject.  With the advent of safe, modern methods to monitor prostate cancer over the past 36 months, it is disturbing to have to report that radical prostatectomies for the same period are up 50%.

There are three likely reasons for this distressing increase:

First, because a urologist is a surgeon, it is only natural, providing you are under age 75 and your overall health is sufficiently good, that his treatment of choice would be surgery. And while a urologist is legally obliged to acquaint you with other forms of treatment available, not only have urologists made a huge personal investment in learning how to perform a highly complex procedure, but also they genuinely believes that surgery provides your best chance for a cure.

Second, although prostate cancer is typically a non-life-threatening disease, many men (like my friend Max) are highly motivated to be rid of the damn disease, to “just cut it out,” despite the risk of becoming impotent. They find it hard to believe that any kind of cancer can remain dormant for years, even decades, and so they rush into surgery without taking into account that even the most talented surgeon cannot guarantee a permanent cure, let alone know for sure that he can save the nerve bundles that control erections.

Three, probably the main reason why surgery is up 50% is that many men today are lured into undergoing a prostatectomy by the high-tech glamour and all the marketing hype surrounding “the robot that can operate.” But as I pointed out in my blog “The Robots Have Landed,” it is the man behind the robot who is actually performing the procedure, and a good outcome depends on the experience and skill of that surgeon. The learning time is significant—a urologist needs to perform as many as 200 procedures to achieve full competence.

And then there’s this strange irony: If it isn’t necessary for you to undergo an invasive procedure—particularly one where you risk impotence and other surgery-related, irreversible side effects—the fact that the technology available is greatly improved is irrelevant.

So do your own homework. Talk with other men who have faced the choices you are facing. Get a second opinion. Interview a prostate oncologist. There’s one thing to take comfort from despite your diagnosis, and it’s this: For 28 out of 30 men prostate cancer is no more life threatening than chronic asthma.
If there’s a mantra, a battle cry for the great majority of us with non-aggressive prostate cancer, it is this: “Die with it, not from it!” I have those six words taped to my shaving mirror.