Some things not only bear repeating, they require it. Every year, in spite of all the progress made in the past half century, approxiametly another quarter of a million men are diagnosed with prostate cancer and face the daunting challenge: What treatment, if any, would be best for me? What treatment would be the least likely to put me at risk for side effects more serious than the disease itself?
Choosing a treatment plan that you can live with is an essential part of coping with prostate cancer, it is a tough decision to make. All too often, there is no clear-cut “best” treatment, and you will get differing opinions from specialists. Your urologist will have a natural bias toward surgery (that is, after all, his specialty), a radiation oncologist’s bias will be toward radiation. Then too, friends and family will have different stories to tell that will further confuse you. Complicating the complex decision making process is the fact that all prostate cancer treatments have significant side effects. One thing is certain: the decision you make significantly alter the quality of the rest of your life.
After your doctor has evaluated the test results and you know the grade and stage of your cancer, there are other factors to consider. The first is your life expectancy, and this, of course, depends on your general health. If you have no other serious health problems and you are likely to live at least ten or more years, chances are your doctor will recommend more aggressive treatment. However, age is also a major factor, and doctors are often reluctant to pursue aggressive treatments with men older than 70 or 75, especially if the cancer is not fast growing. All the more reason to consider possible negative side effects of any treatment you choose.
Unless your PSA is rising fast, or “doubling,” I cannot repeat too often that there is no reason to rush into treatment that you might live to regret. You have to navigate a complex diagnosis, and you need to gather as much information as you can and consider all possible options before deciding which treatment is the right one for you.
And here’s something I learned early on: No matter how much you trust your doctor, you should get a second opinion, preferably from a medical oncologist who specializes in prostate cancer. Someone who is familiar with all the available reatments, who isn’t pushing one treatment over others, and who will give you an unbiased opinion.
If you have a low-risk or intermediate-risk cancer, the main treatment options to consider are watchful waiting (also termed “Active Surveillance”), surgery, radiation, and hormone therapy. Each has its risks and benefits and you need to investigate all of them-thoroughly. If, however, your cancer is high risk or more advanced, your treatment plan will be more complicated. Yourr options may well include a combination of these therapies, as well as chemotherapy, immune therapy, and gene therapy.
In a state of major shock after your diagnosis, you may be inclined to accept whatever treatment your doctor recommends. However keep in mind that it is very difficult for doctors who treat prostate cancer regularly not to have strong feelings that favor their own specialty. You are the one who has to live with the results if the treatment doesn’t work out well, and therefore it is you who must have the final say regarding which course to take. Never forget: if you have to get cancer, prostate cancer is the best kind to have because in the great majority of cases it is slow growing, and not only manageable but curable.
In my case, I was convinced that my prostate cancer was the tortoise and not the hare; that it was no more threatening than chronic asthma, and that I would die with it, not from it. Now almost a quarter of a century has passed. Except for a year of hormone blockade a decade ago, I have stuck with the practice of Active Surveillance.
From everything I have seen and experienced, there are a few questions I would want answered if I were making a treatment decision today. Here they are:
What new drugs and/or treatments are on the horizon? What’s in the testing stage? How promising does it look? How long are we talking about before it comes on line?
Can I reasonably take the chance, given the degree of aggressiveness of my cancer, that waiting will result in my having a better quality of life?
Given the decision I finally make, what are the odds of my being cured?
And finally, if you are thinking about Active Surveillance, here is perhaps least discussed consideration:
Have I got the temperament to live with even a small amount of cancer in my body?
The answer to that last question is, for most men, the pivot upon which their decision must swing. So face it. Answer it. And then, depending on your answer, make your decision.