The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

Tuesday, May 15, 2012

Prostate Cancer? Newly Diagnosed? Gearing Up for Your Journey (Part 1)


You’ve just received what sounds and feels like a death threat. So what do you do? What steps do you take? You may have heard all this before. But we all absorb vital information at different rates, in different ways. Blessed are those of us to whom the Latin proverb applies: Verbum sat sapienti est: “A word to the wise is sufficient.” I know that in my case quite a few repetitions were required to spur me into action.

I’ve written about this subject in “A Strategy for Self-Empowerment,” and yes, now as then, we’re talking about “patient empowerment.” It is vital that you learn all you can about your disease because, like it or not, you are the final authority in making your treatment decisions. And it is equally important not to rush the treatment selection process or allow anyone else—including respected medical professionals—to stampede you into making a decision before you have done your due diligence.

Your first step after being diagnosed is to understand the concepts of staging and grading. The grade of your cancer will tell you how aggressive the cancer cells are; the stage tells you how extensive or advanced the cancer is—whether it is still confined within the prostate gland or has spread beyond the prostate. This information will determine your prostate cancer’s risk factor, and help you decide which treatment option is most appropriate for you.

Your risk level determines your treatment, and not all prostate cancer requires immediate treatment. If your stage and grade put you in the Low-Risk category, your least invasive choice would be Active Surveillance—simply monitor the situation with regular PSA testing, prostate exams, and periodic repeat biopsies.

If you fit into the Intermediate-Risk category you have many treatment choices, and in order to make the best decision you need to get opinions from multiple specialists with state-of-the-art knowledge, and equipment. You will have already seen an urologist who, if you are a candidate for surgery, is likely to have recommended a radical prostatectomy. If this is the case, don’t be shy.  You owe it to yourself to ask the tough questions: What are the risks? How many procedures has he performed overall, and how many within the past twelve months? Does he perform nerve-sparing surgery, and if so what is his success rate with preservation of potency and continence? You will usually find the most experienced surgeons at university centers. But an urologist who is well trained and does 100 procedures a year—and who you feel comfortable with—is also a good bet.

However, before making a decision, you should consider the other options available to you. Consult a radiation oncologist about brachytherapy (radioactive seed implantation). Learn the pros and cons of Intensity Modulated Radiation Therapy (IMRT), a precisely targeted procedure that delivers high doses of radiation to the prostate and, when necessary, to the seminal vesicles and other surrounding tissue. Once again you need to ask about success rates, and about the possible side effects of both radiation treatments.

Men in the Intermediate-Risk category also need to consult a medical oncologist about hormone therapy, a treatment that blocks the male hormone testosterone and significantly slows the spread of the cancer—often for years—during which time, less toxic and more effective treatments are likely to become available. Hormone therapy does not promise a cure, but it is a viable, noninvasive alternative to surgery or radiation.

If you are in the High-Risk category, you will usually need two or more different kinds of treatment—probably hormone therapy plus radiation, and possibly chemotherapy. But don’t panic. There are a number of exciting new treatment methods in the pipeline, so even if you fall into this more serious category you are not looking at an imminent death threat!
It goes without saying that there are pros and cons to all prostate cancer therapies. And when selecting a treatment plan, much will also depend on your age, your general health, your life expectancy, and your tolerance for the inevitable risks and undesirable side effects of whichever treatment you choose. I am not suggesting that you back off from a definitive form of treatment because of potentially adverse side effects, but bear in mind that quality of life is also a prime consideration when deciding which treatment is best for you. And remember: In most cases prostate cancer is the tortoise of cancers, and--especially if you are in your seventies or older--you are more likely to die with it, not from it. A word to the wise . . .

No comments: