BY RALPH BLUM
you don’t live in a city, finding a urologist who specializes in treating
prostate cancer can be a major challenge. Usually your choice will be limited
to who your primary care doctor will refer you to, generally a local urologist. But before you take this step you need to be
aware that all urologists are not created equal.
the average community urologist has a medical practice most of which involves
treating problems like infections, impotence, incontinence and kidney stones.
He may be an excellent doctor, but he does not have time to keep up with what
is new in the fast moving prostate cancer field. Also, without the opportunity
to treat large numbers of men with this disease, how can he be familiar with
the advantages and disadvantages of all the new treatments?
you need to develop the “I’m from Missouri and you’ve got to show me” mindset
and ask the tough questions: How many cases of prostate cancer has he treated
successfully? And if he recommends surgery, how many radical prostatectomies
has he performed overall, and how many in the past twelve months? Does he
perform nerve-sparing surgery, and if so what is his success rate with
preservation of both potency and normal urinary function?
you have the aggressive, high-risk form of prostate cancer my best advice is to
resist your natural desire to rush into treatment that will compromise your
quality of life. Of men diagnosed over 50%have slow-growing, low-risk
disease and do not need immediate treatment. However, if you have the
“just get it out” attitude, bear in mind that your community urologist is most
likely not doing anywhere near enough radical prostatectomies to qualify as or
the well-documented over-diagnosis and over-treatment of prostate cancer,
during the past decade, the number of prostatectomies performed each year has
more than doubled. And since all the marketing hype surrounding “the robot that
can operate,” increasingly men are traveling to high volume centers that offer
robotic surgery. But remember, it’s the man behind the robot who is
actually performing the surgery, and you don’t want to be on his learning
curve. Unless you find an experienced and highly skilled surgeon, a
satisfactory outcome is extremely unlikely.
men are way too motivated to submit to radical treatment for what is typically
a non-life-threatening condition. A combination of the urologist’s preference for
surgery and most men’s desire for closure, leads to tens of thousands of
unnecessary radical prostatectomies every year. You are about to make a pivotal
decision that will affect the rest of your life. So before you make any
treatment choice, you owe it to yourself to get a second opinion from a
prostate cancer specialist—even if it means traveling to a city where such
practitioners are available.