Newly Diagnosed Prostate Cancer

Don't Rush into Treatment

Prostate Cancer Diagnosis
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Many forms of newly-diagnosed prostate cancer act more like a chronic condition than a life-threatening cancer. This realization creates unexpected challenges as selecting treatment requires striking a balance between the effect of treatment on quality of life and longevity.  Briefly, there are four broad categories of therapy for men with newly-diagnosed prostate cancer to consider.

1.     No Treatment

It is now becoming clear that thousands of men undergo aggressive treatment every year for a type of prostate cancer that will never be life-threatening. Active surveillance is their best option.  Active surveillance means that treatment is reserved only for the men who show cancer growth while undergoing close observation with PSA blood checks and periodic prostate scans.  This is the most popular option for men with the Low-Risk type of prostate cancer (Gleason grade 6 or less).

2.     Local Treatment

Surgery, radioactive seed implantation, targeted beam radiation and cryosurgery are all local treatments, which when administered by experts, can be expected to eradicate the cancer within the prostate with a high degree of consistency.  There are two potential drawbacks associated with these options.  First, these treatments can cause irreversible side effects to adjoining structures such as nerves that control erections, urinary, and rectal function.

  Second, if the cancer has already spread outside the prostate the cancer won’t be cured.

3.     Systemic Treatments

Anticancer compounds that circulate in the blood treat cancer both within the prostate and throughout the rest of the body.  These types of agents include herbal, hormonal, immune and chemotherapy treatments.

  Systemic treatments can effectively suppress cancer but they usually fail to eradicate it completely.  Systemic treatment aims to convert prostate cancer into a chronic, non-progressive condition by keeping it stable, hopefully for many years. All systemic treatments have side effects, each with their own unique profile. 

4.     Combination Therapy

Combination therapy uses systemic treatment and local treatment together.  Combination therapy achieves the highest cure rates but is only appropriate for patients with aggressive prostate cancer, the type that would relapse with local therapy alone. Well-designed studies have clearly shown that combination treatment offers the best chance for cure in patients with the more aggressive types of prostate cancer. 

Selecting Treatment

Prostate cancer patients are more involved in treatment selection than those diagnosed with any other type of cancer. This is because in treatment selection process the best choice is based both on quality of life considerations and survival considerations.

  Therefore, patients must learn about all the potential side effects of each treatment option and compare it with the other options before they can make an informed decision.

Patient involvement in the treatment selection process is an absolute requirement but there are potential pitfalls. Clear and objective reasoning may be difficult during a time of shock and grief brought on by the diagnosis of cancer.  Strong emotions are also stirred up as one is forced to face the possibility of treatment-related, life-altering side effects that can impact sexual, rectal, and urinary function. Fear can drive patients to hurried treatment decisions instead of waiting until they have a full understanding of all the information. Despite reassurances, it is hard for patients to escape the lingering concern that unless they act swiftly, the cancer will grow and spread.  

Recommendations for Newly-Diagnosed Patients

1.     Don’t rush into immediate treatment!

2.     Obtain thorough and proper staging so you can estimate the risk that the cancer has spread to a location in the body distant to the prostate. Clearly understanding your prognosis (not the prognosis of cancer in general) is the most important first step toward getting an accurate perspective on your situation.

3.     Educate yourself thoroughly about this disease via sources such as the Internet, books, and support groups focused on prostate cancer. 

4.     Whenever possible, seek advice and treatment from doctors who specialize in treating prostate cancer. 

5.     When the word “cancer” is mentioned emotions run high.  Try to base your treatment choice on facts rather than feelings.

6.     Partner with one or two clear-thinking and intelligent friends when you go to consult with the doctor.  Two or three heads are better than one.

7.     If there are two equally good appearing treatment options pick the option with reversible side effects rather than the option with irreversible side effects.

8.     If you have surgery, radiation or seed implantation there is only one shot at doing it right.  Make every effort to ensure that the doctor is amongst the very best at what he does.

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