News reports this year about prostate cancer may have many men scratching their heads in confusion about when to treat prostate cancer and how often to get a PSA test. Screen for prostate cancer? Don’t screen? Have surgery or radiation therapy? Aggressive therapy or “wait and see?”
MyLifeStages talked with two men who deal with prostate cancer patients every day to get their perspectives on this disease. San Francisco urologic surgeon Rodman Rogers, M.D., of California Pacific Medical CenterOpens new window and Frank dela Rama, oncology clinical nurse specialist with Palo Alto Medical FoundationOpens new window and author of our prostate cancer blog.
While the subject remains confusing, Dr. Rogers and nurse navigator dela Rama shared some importance perspectives:
The recent report by the U.S. Preventive Services Task Force questioned the benefits of wide-spread PSA screening because it may have led to overly aggressive treatment, not because it was an ineffective tool for diagnosing cancer.
“While prostate cancer is the second leading cause of cancer-related death in men, and treatment for prostate cancer does save lives, data suggests that many men who had treatment for prostate cancer over the past decade may have only a slight survival advantage over men who elected an active surveillance approach,” says Dr. Rogers. “If their cancer was low grade and small volume, many men may have lived out their lives with their cancer and avoided the side effects of prostate cancer treatment.”
But screening is required to determine the aggressiveness of the cancer and to therefore make an informed decision about what approach is appropriate for each individual patient.
“Before the PSA blood test, many men were diagnosed with prostate cancer after it had spread to other parts of the body and was causing pain and symptoms,” notes Dr. Rogers. “With PSA screening, and treatment when appropriate, the picture has changed entirely and the numbers of men with metastatic disease when first diagnosed with prostate cancer have vastly improved. “
It is important that patients understand the risk posed by the cancer versus the side effects of treatment. A physician who specializes in prostate cancer can help patients weigh these two factors, which are unique for each individual.
Being diagnosed with cancer is certainly frightening, and it’s understandable that men want to “do something.” However, treatment does carry some risk of side effects that include changes in urinary and erectile function.
“Both types of treatment for prostate cancer – radiation and surgery – are impacting ‘prime real estate’,” says dela Rama. “If the man has aggressive cancer, then a treatment decision must be made, and the trade-off of potential side-effects is certainly worth it.”
But both experts note that some men with slow-growing prostate cancer may be able to live out their lives and ultimately die of something else, not of their prostate cancer. “For these men,” says Dr. Rogers, “it would be a shame to live out the rest of their lives with urinary and erectile problems when these may have been avoided.”
Dr. Rogers sees the next frontier in prostate cancer focused on determining exactly who needs treatment, at what point treatment should be considered, and minimizing treatment-related side-effects.
“Men need to understand the actual risk that their prostate cancer poses, because in some cases, that risk may be very low,” says Dr. Rogers.
While he advocates screening for prostate cancer, he also notes that the incidence of prostate cancer is very high, particularly among older men, and patients must be prepared to learn more.
“For men with less aggressive, low- grade forms of the disease, watchful waiting or active surveillance can be a viable option – meaning the cancer is closely monitored and treatment is postponed until there is evidence the disease is growing,” said Dr. Rogers.
Dela Rama discusses some of the factors to consider when “watchful waiting” is the recommendation in this blog post, Actively “Doing Nothing.”
The basic methods of treating prostate cancer remain the same – surgery to remove the entire prostate gland; or radiation to attack the cancer cells within the prostate. However, both methods are improving in ways that can minimize the chance of the dreaded side-effects of incontinence and/or erectile dysfunction.
Robotic laparoscopic surgery is the mainstay of prostate removal now, and many experts believe this method allows the surgeon to see and work within the pelvis with much greater accuracy.
Radiation treatments are also improving, with new methods that allow more precise targeting of radiation beams to just the areas of tumor. This can spare the “innocent bystander” issues of the urethra and the nerves and blood flow involved in erections.
Each treatment method contains its own set of pros and cons, including the risk of side-effects, the immediate discomfort and disability, and the disruption to a man’s routine. Dr. Rogers emphasizes that men should not feel pressured to decide quickly on their treatment plan.
“I don’t ever remember having a patient with cancer confined to the prostate where a quick decision was needed,” says Dr. Rogers. “Men and their families have lots of time to conduct research, to get a second opinion and to be clear about the treatment they choose."
(Read another of dela Rama’s blog posts on how we make our decisions in Winning Strategies in Poker and Prostate Cancer.)
Dela Rama notes that there is a growing focus on what is called “cancer survivorship.” This is good news. Cancer patients who are successfully treated live out many years -- often decades -- post treatment. In some cases, there are latent issues that arise from previous surgery or radiation therapy, which may be experienced years down the line. Once treatment is completed, it is good for the man and his family to know all about his particular type of treatment and what side-effects, if any, might be anticipated later in life. Cancer support groups can also be a very useful tool in building a post-cancer lifestyle, bringing men into the companionship of others who have walked the same road. (See our class listings for cancer support groups near you.)
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