Making an Informed Decision about Prostate Cancer

BY MARK SCHOLZ, MD

What Is the Best Therapy for Me?

This is one of the greatest questions for men with prostate cancer. How do you arrive at a reliable answer? Your doctor, no doubt has showed you biopsy results, PSA readings and Gleason scores. You have been warned you about the dangers of metastasis and treatment side effects—such as impotence and incontinence. But when it comes to that fundamental question—what the best therapy is—you were probably told you need to decide.

Prostate Cancer Is Not One Illness

Prostate cancer is a broad range of conditions ranging from a few microscopic cells found on a needle biopsy to a life-threatening metastatic condition. Such a wide spectrum requires treatment customized to your stage. There are at least 15 stages of prostate cancer. The first step, therefore, is to determine the cancer’s stage. To determine your stage, take the short quiz posted on our website, Key to Prostate Cancer.

Knowing Your Stage Promotes Self-Reliance

After you know your stage you will be prepared to defend yourself against the know-it-alls who eagerly tout a one-size-fits-all treatment for everyone. Whether you are being pressured by a doctor, family member or friend … recommending one type of treatment for everyone is an unmistakable sign of ignorance. Good decisions result by obtaining balanced information about treatment options that are stage-appropriate.

Give Yourself Time to Learn

Prostate cancer is far less malignant compared to other cancers. More than 85% of men will live a totally normal life expectancy and die of other age-related illnesses. Unfortunately, in the rush for a cure, patients fail to educate themselves about irreversible treatment-related side effects. The prostate is in a very precarious location: just under the urinary bladder. This means treatment can cause permanent sexual and urinary dysfunction. By understanding their stage, and thus gaining an accurate estimate of the cancer’s potential impact on survival, patients can assess the risks and benefits of various treatments in a realistic context.

Surgeons Still Dominate Treatment Realm

At one time, not so very long ago, surgery was the only effective type of anticancer therapy. So, merely for historical reasons, when first diagnosed, patients are still referred to a urologist, who is a surgeon. Prostate cancer is the only common type of cancer still managed by surgeons. Other types of cancer—breast, colon, pancreas, stomach, bone, etc.—are all managed by internal medicine doctors with subspecialty training in cancer—medical oncologists. Medical oncologists, who do neither surgery or radiation, are trained in treatment selection. As you can imagine, surgeons, who spend most of their time in training learning how to perform surgery and avoid killing the patient, have little time to learn anything else. Unfortunately, when trained to be hammers, everything they see ends up looking like a nail.

Patients should understand that their urologist despite claims to the contrary, already knows the type of treatment he wants to do. The problem, as he sees it, is convincing you. Urologists are very intelligent and in their interactions with you, may present you with a soft or hard-sell approach depending on whether you appear to be skeptical or trusting. It is crucial for you to realize that surgery and radiation are only a few of the many options open to prostate cancer patients. Depending on the cancer’s stage, it is possible that neither is the best option.

Consider Consulting a Prostate Oncologist

As medical oncologists and internists, we have no preset agenda to recommend one therapy. Since we perform neither surgery or radiation, our goal is to guide patients to the treatment we would use for ourselves if we were diagnosed with the same stage of prostate cancer. We personalize our recommendations depending on each patient’s individual characteristics. We educate and empower our patients with information about their stage of disease they need so they can participate intelligently in the decision-making process.

We Are Unique

We are easily the largest prostate oncology clinic in the country. Our three, full-time prostate oncologists actively care for over 2,500 men with prostate cancer and see more than 500 new cases annually. All treatments, including active surveillance, hormone therapy, immunotherapy, surgery, radiation, brachytherapy, cryotherapy, nutritional therapies, alternative therapies, and chemotherapy, are considered. As board-certified internists, we look at treatment with an eye toward the whole-patient. We are not just prostate doctors. Call us and make an appointment for consultation, either in person or by phone. The unbiased and expert advice we provide may end up sparing you from inappropriate or unnecessary treatment and irreversible side effects.

1 Or radiation therapist, who is trained primarily in the safe administration of radiation.

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