Illustration by Peter Hoey
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Surviving Prostate Cancer
By Jay Griffin, September & October 2009
Prostate patients face a confusing array of treatment options—including no treatment at all. Here's how to make the right decision
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When psychiatrist E. Fuller Torrey, M.D., was diagnosed with prostate cancer, he found himself in uncharted medical territory—not only as a patient, but as a physician. Unlike patients diagnosed with other diseases, for which treatment guidelines are fairly clear, Torrey was stunned to realize that selecting a treatment plan for prostate cancer would be solely his responsibility.
"The single most shocking thing about going through the whole experience was that nobody was willing to say, 'This is what you need to do,' " says Torrey. "This is a type of cancer for which there are several options, and there's not a vast literature that says one is better than the other for the majority of patients."
The not-so-exclusive men's club of prostate cancer survivors is more than 2 million members strong and growing. As Torrey discovered, membership brings with it some hard choices about what to do and how to cope with the side effects. Fortunately, newer treatments are being developed—and standard treatments are being improved—giving men the tools they need to make the right decisions. Here's what you need to know.
To treat or not to treat
Surprisingly, the first decision is whether the cancer needs to be treated at all. For men who have small, low-grade localized tumors—or those whose life expectancy is fewer than ten years, because of advanced age or serious health problems—a wait-and-see approach called watchful waiting or expectant management may be appropriate.
"Not treating is actually a very reasonable option, and I think it's one that's too often overlooked," says Mark Litwin, M.D., professor of health services and urology at UCLA.
One in every six men will be diagnosed during his lifetime.
Watchful waiting doesn't mean passively standing by as cancer progresses. It means undergoing frequent PSA screening tests and repeat biopsies, and reassessing the need for more aggressive treatment over time.
That said, most men are simply not comfortable living with prostate cancer, even low-risk prostate cancer. The natural response is to do something, and quickly.
But as you contemplate your options, physicians suggest you keep two facts front and center.
First, you have some time to do research, get opinions from different specialists, and make a carefully considered choice. Most prostate cancers grow slowly, and research shows that delaying treatment for up to three months does not affect survival rates or the ability to control the cancer.
Second, choosing one treatment over another is not likely to be a matter of life and death.
"A lot of people think that the treatment determines the outcome, but that's not necessarily true," says Ian Thompson, M.D., chairman of the department of urology at the University of Texas Health Science Center, San Antonio. What's more important is the grade—or severity—of the tumor.
Ultimately, your choice of treatment should reflect your own preferences. Each treatment has tradeoffs, and understanding them is the best way to minimize regret and feel confident about the choice you've made.
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