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

Tuesday, February 18, 2014

Taking Charge of Your Treatment


The condition known as “selective inattention” plagues our understanding:  We hear what we want to hear. I can think of no way around that defect. Some things just have to be repeated. And repeated, until they sink in.

I am now approaching my 82nd birthday, and my long and often humbling affiliation with prostate cancer began when I was fifty-eight. A slightly elevated PSA and a “lump” in my prostate led to a biopsy that the urologist evaluated as “suspicious for well-differentiated adenocarcinoma.” The intervening years have given me a profound education in taking responsibility (and at times failing to take responsibility) for decisions that have affected not only my health but also my emotional well-being.

If you have just been diagnosed with prostate cancer, you are walking into the middle of what my oncologist and writing partner, Mark Scholz, MD, calls “a medical minefield.”  Choosing a medical team that will lead you safely through the prostate cancer minefield is arguably the most important decision you will ever make.  And taking an active role in your team is the second most important. You are the person who has cancer, and a passive, “Whatever you say, doc,” attitude will not serve you well.

You need to be aware that over-diagnosis and over-treatment of prostate cancer are rampant. There are many reasons that so many doctors over-treat and over-test, not the least of which is that most of them are reimbursed for how much care they deliver. In fact hospitals, doctors, medical equipment manufacturers, pharmaceutical companies—all organizations that derive their revenue from cancer diagnosis and treatments--have a deeply vested interest in the “more-treatment-is-better treatment” paradigm. However, in the great majority of cases prostate cancer is very slow growing, so there is no reason to panic, or to act precipitously. So that for 9 out of 10 men reading this blog, “active-surveillance” should be your first step on this cancer journey as you weigh your treatment options—which must include the possibility of living with prostate cancer untreated.

You also need to be aware of the “Hammer Syndrome:” If you’re a hammer the whole world looks like a nail. To the surgeon the best option looks like surgery. A radiation oncologist will see radiation as the answer. A medical oncologist is more likely to suggest drugs. It can’t be repeated too often: Before you reach any treatment decision take the time to do as much research as possible, and make sure you explore every option. Do not go to just one doctor and say, “Treat me.” Get a second opinion. Ask questions. And don’t be pressured by anyone to hurry a decision.  Weigh all the pros and cons of each treatment recommended, and look carefully at prostate cancer from the potential cure versus quality-of-life perspective. Far too many men rush into radical treatment for what is typically a non-life-threatening condition when their number one priority should be guarding and preserving quality of life.

Few of us have any objective way to judge whether a particular doctor has the medical knowledge, skill and experience to treat our specific case with success.  I have dodged some major bullets over the years, but eventually it was my good fortune to fall into Mark’s compassionate and capable hands. And I can tell you that confidence in your doctor and belief in your chosen treatment are two of the great intangibles in a successful recovery. And guess what? Your successful recovery may include living a long and productive life with a chronic form of prostate cancer. At least, it has worked for me.

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