Selecting Treatment for Prostate Cancer

"You mean you have never heard of 3 Tesla multi parametric MRI?” exclaimed a recently-diagnosed prostate cancer patient to his doctor.  How could his doctor be unacquainted with modern prostate imaging? It’s shocking when a patient realizes he is in possession of more medical information than his “expert.” 

No One Can Know Everything
Actually, this type of situation is frequently encountered. It’s not surprising when you consider the explosive growth rate of new medical information.

 It’s impossible to stay abreast of every new development.  Even though urologists, for example, “specialize” only in diseases of the urinary system, their area of responsibility demands expertise in urinary infections, prostate enlargement, prostate infections, sexual dysfunction, fertility and kidney stones, just to name a few.  Most important of all, if they are going to take responsibility for their performance in the operating room, they better be well-practiced experts at surgery. 

Prostate Cancer Alone is Quite Complex
Prostate cancer is certainly intricate enough to keep a specialist fully occupied. Just staging the disease, for example, is complicated. The staging system functions by estimating the likelihood of microscopic metastases through the interpretation of PSA levels, Gleason grade, and a percentage of cancer-containing biopsy cores.  Now, new imaging techniques are providing further input of data about the size and location of the cancer within the prostate gland.

 And now, molecular profiling is commercially available.  Staging prostate cancer has become a continually developing art form.

Advice Delivered from a Level Playing Field
Equally important is the need to seek out unbiased treatment advice. Unfortunately, the process of rendering advice about treatment options is easily slanted.

Urologists (who are surgeons) usually recommend surgery.  Radiation therapists lean toward radiation. This is not to imply that these physicians have less than the best intentions.  Over time they just become convinced that what they do is the best option for their patients who are consulting them.

What You Don’t Know Can Hurt You
The number of treatments available for men with newly-diagnosed disease is rapidly expanding.  For example, what was previously known simply as “radiation” now includes IMRT, Proton therapy, Cyberknife, SBRT and multiple different types of seed implants.  Hormone therapy options have now expanded beyond traditional Casodex and Lupron to include Zytiga and Xtandi. To minimize the risk of lingering damage from hormone therapy doctors need training in diet, physical fitness, bone integrity and sexual health.  Treatment of relapsed or advanced prostate cancer requires physicians who are conversant in genetic typing, modern PET scans, immunotherapy and injectable radiation.

Every Journey Begins with a Single Step
Clearly newly diagnosed prostate cancer patients are faced with daunting situation and there is no simple answer to this tangle of complicated issues.  However, the newly diagnosed cancer patient is far from helpless.  He has two overriding responsibilities.  First, he must learn as many facts as possible about the different treatments for his specific type of prostate cancer.  Second, he must use discernment in the selection of which physicians to consult.

There is Time to Learn
With prostate cancer there is rarely a need to rush into making a treatment decision. Thankfully it is usually slow growing allowing plenty of time to get educated about the scientific facts.  Ultimately, all claims about treatment need to be supported by references published in the scientific literature.  Selecting treatment for prostate cancer is a high stakes proposition with potential risks to sexual function, urinary function and longevity.  Patients need to aggressively educate themselves so they can responsibly take a leadership role in the decision-making process.  

Continue Reading