Steve's Story

Getting the Best Treatment for Prostate Cancer

 

Steve Fleischmann, age 47 when he was diagnosed with prostate cancer, opted for surgery. He had a radical prostatectomy, in which the entire prostate gland is removed, performed by Dr. Paul Lange at the University of Washington Medical Center, an SCCA parent organization.

Surgery was not the only option Fleischmann considered to treat his localized prostate cancer. He also considered "seed implants," a type of radiation therapy, but rejected that choice because, he says, "I needed to know that my cancer was gone."

If you have prostate cancer, the treatment your doctor or doctors suggest will depend on several factors, including your age, your general state of health, the cancer itself—how aggressive it is and how far it has progressed—and, to some degree, the specialty of the doctor you consult.

When it comes to localized prostate cancer, Dr. Lange says, the two broad categories of treatment choices are surgery and radiation. At this point, no studies have definitively established that one treatment is better than the other.

"Your decision is complicated further by the reality that specialists generally recommend the procedure that falls within their own specialty," Dr. Lange writes in his book, "Prostate Cancer for Dummies" (Wiley Publishing, 2003). "…[Y]ou may want to keep in mind the surgeon's bias for surgery and the radiation oncologist's bias for radiation treatments."

To help you consider your options, Dr. Lange suggests consulting with a medical oncologist, who treats cancer with drugs, including chemotherapy. Since you won't need drugs to treat localized cancer, this doctor can give you an unbiased opinion.

Too old for surgery?
Generally, when a man is diagnosed with prostate cancer at age 70 or 75, his doctor will not suggest surgery as an option, but may recommend "watchful waiting" rather than more aggressive treatment. One reason for this is that prostate cancer generally is slow growing. It can take 10 or more years for the cancer to spread enough to kill you, so if you have a life expectancy of 10 years or less, it may not make sense to treat it aggressively.

"Watchful waiting" doesn't mean sending you home to do nothing, of course. You would see your urologist frequently for PSA tests and checkups.

Dr. Lange thinks that using arbitrary age cut-offs to make treatment decisions is "somewhat discriminating," so he focuses on a man's overall health and life expectancy, rather than just his age, in making treatment suggestions. "Some men who are in their early 70s are robust and healthy," he says. "If your doctor refuses to treat your prostate cancer solely because of your age, even though you're in otherwise good health, consider getting a second opinion."

Treatment choices
In addition to surgery and watchful waiting, prostate cancer options include:

• Radiation therapy, either external beam radiation therapy or brachytherapy (radioactive seed implants), or sometimes both 
• Hormone therapy, which can slow the rate at which the cancer grows 
• Newer options such as cryosurgery (freezing the cancer) or microwave therapy (killing the cancer with heat).

Chemotherapy is rarely used to treat prostate cancer initially, but it is now an option with some proven benefit to treat prostate cancer that has spread, or metastasized.

A final suggestion from Dr. Lange: Don't rush into a decision about treatment. He says most men can safely take one to three months to do research, get a second opinion and carefully consider their options.

May 2004