10 Ways to Cope With Prostate Cancer

How to Achieve the Best Outcome

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Every year, 200,000 men are diagnosed with prostate cancer. Confusion about optimal treatment is widespread. The doctors even defer to their patients saying, “Since it’s about quality of life, the decision about which treatment to use is up to you.” In my opinion, this is an abdication of physician responsibility. Nevertheless, this is what prostate cancer patients face. Here are 10 simple guidelines to help shoulder this weighty burden.

Get Educated

Optimal treatment depends on finding reliable sources of information. Thankfully, all kinds of information are available on the internet. But they are not equally reliable. In fact, most online resources are slanted toward one agenda or another. The truth can be found, but you need to find the source documents—the original studies on which medical recommendations are based. The field of medicine is built upon observational studies performed in patients who are treated in various ways and then observed over time to determine their long-term outcome.

When reviewing studies, the challenge is to find the ones that are relevant to your specific situation. If your doctor claims, “Radiation is better than surgery,” ask him to provide the original study upon which this claim is based. Read the study with the following questions in mind:

  • Do the patients have the same stage of prostate cancer as me?
  • Are at least two groups of patients being compared?
  • Did multiple institutions collaborate on the study?
  • Is it in a premier publication like the New England Journal of Medicine?

If the doctor you are consulting only does one type of treatment, as is usually the case with most prostate cancer doctors, he should be able to provide you with a recently published, compelling study that backs up his assertions.

Leave Preconceived Notions at The Door

The educational process for prostate cancer must begin afresh. Patients usually bring wrong assumptions to their initial consultation. Cancer is such a powerful word and becomes so intrusive in our minds that the resulting emotions make clear thinking impossible. Being motivated to save your life and motivated to get aggressive treatment are entirely appropriate if your life is in imminent danger. But with prostate cancer, this is rarely true. As you study the situation further, you will begin to realize that the biggest threat is to your quality of life. The deadliness of other types of cancer is undisputed. But don’t fall into the trap of thinking that prostate cancer is like other types of cancer. It’s not.

Don’t Go It Alone

Bring a partner to every consultation. Two heads are better than one. Three may be even better than two. Two people remember more and comprehend better. Along these lines, consider bringing a tape recorder to your consultations. A well-versed expert can reel off statistics and information at a furious rate. Valuable information can be lost.  If you can bring someone with medical experience, such as a nurse or a doctor, to your appointment that is even better.

Having a second person in the room is also great for emotional support. The process of learning about how to treat prostate cancer can be intimidating and exhausting. Experts may express their views with great vehemence. Multiple consultations may be necessary. Endurance is required; so being able to share the burden throughout the learning process is a big plus.

Know Your Personal Priorities

Yes, of course you want to live! However, prostate cancer treatment selection involves tradeoffs. Sometimes, less aggressive treatment is just as safe and far less toxic. Quality of life priorities vary between patients.

Some men, as they get older, are sexually inactive and unconcerned about losing potency. Conversely, preserving sexual function is often a main priority for younger men (once concerns about survival are addressed). Treatment goals need to be adjusted in accordance with each individual’s pre-existing function and overall life goals.

Acknowledge That Prostate Cancer Is a Business

There is strong profit motive in the prostate cancer world. This hunger for profit needs to be kept in mind when consulting centers that specialize in only one type of therapy. Even though you may encounter a soft sell approach, realize that the pitch has been carefully honed to achieve maximum impact. It is completely ridiculous to believe that a surgery center can provide balanced information about radiation.

The opposite is, of course, also true. Proton Therapy centers are going to be very lukewarm about the efficacy and the desirability of surgery. This does not mean that these different centers do not portray themselves as objective experts who are attempting to provide you with unbiased counsel. No doubt most of the doctors you will encounter possess a level of natural compassion and concern, but their underlying goal is to somehow convince you that their treatment is best.

Check the Accuracy of Scans, Biopsies, and Lab Reports

Up to this point, we have been talking about finding the best quality information. One of the most important sources of information is the basic medical data defining your case—the biopsy results and the scan reports that were provided with your initial diagnosis. Most patients do not realize that the physicians who generate these reports vary in skill and experience. Mistakes can be made in the assignment of Gleason score or the extent of cancer being reported on a scan. Accurate assignment of the disease’s stage is based on accurate scans and biopsy information. Mistakes lead to dire consequences. Most university centers provide second opinions to confirm (or refute) the initial report.

Realize Prostate Cancer Is an Umbrella Term

Once the accuracy of the initial scans and biopsy information is confirmed, the next step is to assign the correct stage to your prostate cancer. The Prostate Cancer Research Institute (PCRI) provides a means of dividing newly diagnosed prostate cancer into five distinct categories; each assigned a different Shade of Blue. The first three categories define a level of risk for men with newly diagnosed disease: Low = Sky, Intermediate = Teal and High = Azure.

  • Sky patients have a type of disease that is essentially harmless and never spreads. These men can be monitored without treatment.
  • Azure patients are at some risk of dying within the next 10 years and a combination of treatments is often best.
  • Teal patients are in between these two extremes and generally should be treated, but with a milder, less-aggressive approach.

The last two shades are Indigo and Royal. Indigo represents the men who have cancer that is relapsed after previous surgery or radiation. Royal represents men with detectable metastatic disease or who have become resistant to hormonal therapy. The complexities associated with treating Indigo and Royal mandate consultation with a cancer expert, i.e. a medical oncologist.

Decide on a Type of Treatment

Treatment selection relies on balancing side effects with the predicted cure rates. One would think that any price would be acceptable to cure cancer, since cancer is potentially fatal. However, it has clearly been proven that many forms of prostate cancer are relatively harmless and maximal treatment under those circumstances makes no sense at all.

There are, of course, in-between, transition types of prostate cancer (generally in the Teal category), where the risk of death is quite low but not quite zero. These are addressed with a balanced approach by using a mild treatment that keeps the risk of side effects to a minimum, but can still cure the disease. So, it is the stage of the disease that has the biggest influence on treatment selection. However, additional issues that need to be factored in are the patient’s personal goals regarding preservation of sexual function, the degree of access to a quality physician to perform the treatment, and life expectancy.

Pick the Right Doctor to Do the Treatment

All doctors are not created equal. Do you need a superstar? Yes! The challenge and complexity of prostate treatment is akin to brain surgery. One slip and irreversible sexual, urinary, and rectal problems can occur. How do you find a superstar? Patients are totally unqualified to judge the skills of a physician. The treating doctor should always be selected by another doctor. Use one doctor to help you select treatment and a different doctor to do the treatment. For patients who have the resources, it often is worthwhile to travel to another city and consult with a well-known prostate expert, one who knows the field well and can identify the superstars with assurance. With most prostate cancer treatments, there is only one chance to get it right and having the very best possible doctor performing the treatment is essential.

Accept That the Existing System Is Less Than Perfect

Modern medical treatment is based upon statistical projections that are derived from long-term studies in multiple patients. However, there is an unpredictable element to the entire process of prostate cancer selection. People can make the right choices and still have bad outcomes. With a sensible step by step process in treatment selection, most people will have outcomes like what was predicted prior to undergoing treatment.

Ultimately, however, there is no crystal ball that can perfectly predict the future. Unexpected side effects can occur. This is an unfortunate and a very frightening aspect of the prostate cancer world. Some individuals become almost paralyzed by the momentous irreversible decisions that are associated with the treatment selection process. It is important to muster a certain amount of courage because at some point, a decision will have to be made and that decision will often depend on information that is partial and less than optimal.

A Word From Verywell

Yes, patients with prostate cancer face a daunting challenge in selecting their own course of treatment. The stakes are very high, impacting both survival and quality of life. Often the information resources are unbalanced or inaccurate. However, a sequential step-wise process that carefully vets the accuracy of the information and the accuracy of the information resources (i.e., the doctors providing counsel) is as beneficial as it is important. Teaming up with a friend or a family member to help you through the process is also essential. Patients willing to do the hard work, put in the necessary hours of study, and carefully reflect on what they learn will achieve the best outcome.

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