Unsolicited Advice from Survivors for the Newly Diagnosed
In 2014, approximately 233,000 men in the U.S. were told they had prostate cancer and to many of them it sounded at best, like the end of their sex life, and at worst like a death threat. In reality, the majority of them turned out to have an indolent form of the disease that was not life threatening and could safely be monitored without any immediate treatment.
Having said that, a diagnosis of prostate cancer is not a walk in the park. Just when you are most vulnerable you are obliged to confront so much complex and conflicting information that to say it leaves you reeling would be an understatement. So your first and most important decision is not to make a pressured decision, not to rush the treatment selection process or allow anyone else—including any doctors you consult—to rush you into undergoing an irreversible treatment until the shock has worn off and you have had time to carefully analyze all the data that applies to your particular case.
The 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. This information, together with your PSA level, will help determine your prostate cancer’s risk factor—whether you are in the low-risk, intermediate-risk, or high-risk category.
If your cancer is low-risk it can be safely monitored with “active surveillance” and does not require any immediate treatment. If you are in the intermediate-risk category, you have many treatment choices, and in order to make the best decision you will need to get opinions from specialists with state-of-the-art knowledge.
You will already have seen a urologist who, if you are a candidate for surgery, is likely to have recommended a prostatectomy. If this is the case, it is essential to ask him the tough questions: What are the risks? How many prostatectomies has he performed overall and how many has he done in the past twelve months? Does he perform nerve-sparing surgery, and if so what is his success rate with preservation of potency and continence? And if you are over seventy, please consider prioritizing almost any other treatment option ahead of going through a major surgical procedure.
Before making a treatment decision you should consult a radiation oncologist about brachytherapy (radioactive seed implantation), and IMRT (Intensity Modulated Radiation Therapy), a precisely targeted type of radiation that delivers high doses to the prostate without damaging surrounding organs. In my opinion both these options are at least as effective as surgery at curing the disease and both are associated with significantly lower risk of long-term toxicity.
You should also 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. Hormone therapy does not promise a cure, but it is a viable, non-invasive alternative to surgery, an effective delaying action. A medical oncologist is a good doctor to consult with as they have no vested interest in either surgery or radiation and can often be helpful in sorting out the conflicting opinions you likely have heard.
If your cancer is in the high-risk category you will usually need two or more different kinds of treatment—probably hormone therapy plus radiation. Some centers even may mention chemotherapy such as commonly done for patients with colon cancer or for women with breast cancer. And there are many new treatment methods in the pipeline, so even if your cancer is aggressive, you are not looking at an imminent death threat.
So do your research and take your choice. And always remember: Prostate cancer is about the best possible cancer to deal with.