PROSTATE CANCER
TREATMENT SELECTION GUIDE
(Updated July 2018 for the USMA Class of 1958)
________________________________________
You have been diagnosed with prostate cancer. The first thing you need
to do is to get educated on what this disease is all about and what
you can do about it so you are better able to play a proactive role in
the selection and conduct of your treatment. The "Bible" on the
subject is Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer"
(5/18). It's out in paperback. Get a copy and read all about it so you
can ask all the right questions and make the best decisions.
There are also many excellent web sites out there covering various
aspects. Here are a few good ones to get you started:
• US Too! offers a range of great information
and resources.
• At is an excellent
matrix covering various aspects of available treatments. Clicking on
each cell provides expanded information.
• The Prostate Cancer Foundation at offers a
very helpful free “Prostate Cancer Patient Guide.”
• Our own site's "Links to Other Sources" at
has many
links to various subjects, from general to very specific.
Get your spouse/significant other involved in the process right from
the start. Her stake in the outcome is as every bit important as
yours, though her priorities may differ. Take her with you to your
consultations with your doctors. You will be under a lot of stress.
She will hear things you miss and will think of questions that you
forget to ask. Coach her in advance as to how she can help.
Get the details of your diagnosis from your urologist to include
location and Gleason score for each positive biopsy sample, and get a
diagram. The details are critical in determining which treatment
options are open to you – the more advanced the cancer, the fewer the
options. If for any reason you have doubts regarding the accuracy of
the results or your doctor's interpretation of them, or if you think
he may not have used the most up-to-date diagnostic tools, get a
second opinion. If your urologist doesn't explain all the current
treatments available and all their pros and cons, get a new urologist.
Each treatment option comes with a likely set of short and long term
side effects and risks involving such things as incontinence and
impotency, and with information on containment or spread, likelihood
of recurrence, quality of life as you define it, and even long term
survivability. Reliable data on survivability for a given treatment is
a moving target. It takes upwards of 5-10 years to develop even as
procedures and techniques continue to improve over time, making
choices all the more difficult.
Given the uncertainties and variable results associated with different
treatments, you need to establish up front just what your priorities
are for treatment outcomes. And your spouse/significant other needs to
be an integral part of the process. For example, she is more likely to
be concerned with your health and survivability than your ability to
perform sexually. Work through this together. You're a team.
When considering treatment options, consult with the specialists in
their respective fields to gain first-hand knowledge to help you make
your decision and best achieve your priorities. Bear in mind, however,
that each specialist tends to favor his/her particular procedure and
is likely to recommend it as your best course of action. So ask a lot
of questions, keep an open mind, and maintain a healthy level of
skepticism.
Along with the diagnosed level of your cancer's aggressiveness, be
sure to take into consideration your age and overall state of health.
If you are diagnosed with early stage cancer, your health is poor and
you stand a good chance of dying from something other than the cancer,
or you prefer to avoid more invasive treatments with incumbent side
effects, you may want to consider watchful waiting/active surveillance
involving more frequent PSA monitoring and substantial lifestyle
changes to control the cancer's development. Subsequent treatment is
available should the cancer progress.
To assist you in making a treatment choice you will be provided a copy
of the class Treatment Selection Table which gives you the contact
information, diagnoses and treatments selected by those classmates who
have already been diagnosed with and treated for PC and have
volunteered to assist newly diagnosed classmates on a one-on- one
basis. Please keep this information confidential with regard to anyone
not listed on the table. Also keep in mind that their circumstances
and priorities for selecting a particular set of treatments may differ
from yours. They will be happy to advise and assist, but should not
attempt to impose their choices on you.
It may also be helpful for you to consult with any physicians you
know, regardless of their specialty, and ask them what course of
action they would take were they to be given a similar diagnosis.
Their professional training and background will enable them to give
you impartial, well-reasoned recommendations, but bear in mind that
the questions you pose are hypothetical and when confronted with a
real diagnosis, their actual choices may differ.
Once you have decided on a particular treatment or combination of
treatments, insure that the specialist you select to perform each
procedure has extensive experience in performing it, has an excellent
success rate and has a reputation to match, i.e. he performs many of
them on a routine basis and is well regarded in the medical community.
You do not need to participate in the development of anyone's learning
curve. Check out his/her background – education and training, where he
has practiced, years of experience, particular subspecialty. What do
other professionals and prior patients have to say? Is he well
equipped to deal with any preexisting health issues you might have or
surprises he might encounter during the procedure? How much time and
individual attention does he give you? What sort of vibes do you and
your spouse get from the encounters? Are you comfortable with and
confident in this individual's abilities?
Each procedure comes with its own set of recovery problems, short and
long term. Query the specialists in detail on these and do your own
independent research. Don't become one of those "What the doctor
didn't tell me." patients. To assist in asking all the right
questions, The Prostate Cancer Foundation offers to email you a .pdf
copy of “Questions to Ask Your Doctor” at
.
You will also be provided with a copy of our Prostate Cancer History
Form for your personal use in maintaining a record of your diagnosis,
treatment priorities, treatment selections and their progress. If in
due course you decide to add your information to the Treatment
Selection Table and make yourself available to assist other
classmates, you can use this form as a basis for one-on-one
consultations.
Finally, bear in mind that your diagnosis is a red flag that your
lifestyle up to this point, together with the genes you inherited from
your parents has not afforded you the protection necessary to avoid
contracting the cancer, given whatever circumstances that may have led
to the diagnosis. Although you had no control over your genetic
inheritance, you can change your lifestyle. So the appropriate
response to this diagnosis is not guilt, anger or self-recrimination,
but rather a firm commitment to make those lifestyle changes necessary
to control and even defeat this cancer. To assist you in doing so,
please refer to our Prostate Cancer Prevention and Control Guide on
our web site at
.
Print out a copy and give it to your spouse/significant other to beat
you on and about the head with when you don’t follow it. You are now
solidly in the control phase. Also, get your hands on a copy of Dean
Ornish's book "The Spectrum." As discussed in the guide, it is an
excellent complement to it. Another is the American Cancer Society's
"Complete Guide to Nutrition for Cancer Survivors"