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Prostate Cancer: Is Waiting an Option?
The truth about "watchful waiting"...and why do they call it that?
A 78-year-old man with heart disease and a few other problems was found to have a prostate cancer. Not a bad one, not a large one. Just an average run-of-the-mill prostate cancer. One that, chances are, will not kill him.
In fact, for many men who are older and may not be healthy, some prostate cancers will not be the cause of their passing (as I get older I think passing sounds better than death). I am sure if you have read enough you realize that most men diagnosed with prostate cancer do not die of it, they die with it.
Cardiovascular deaths are still the biggest killer of men. When talking to patients I like to bring up an old saying "If I do my job right, you won't die of prostate cancer, even if you still have it with you."
So who needs their prostate removed, radiation, hormone therapy or chemotherapy? Who gets to go home and do nothing but check a PSA and prostate exam a few times each year? This is the big question all urologists would like to answer.
In general, it comes down to this -- if it is felt that the prostate cancer will be significant in your expected lifetime, then it is a good idea to have it taken care of. There are almost 50,000 men who die of prostate cancer each year.
With that in mind, and taking into account the different aspects of the cancer and the individual, there are some instances where it is believed that doing nothing may be the best approach. There are some instances where we feel that any or all the treatments will be more hazardous than the cancer, or that the odds are good the patient will die of other causes before the cancer can become a problem.
So if you choose this non-treatment we used to call watchful waiting, what does that mean? First of all, watchful waiting is not a good phrase as it implies we are waiting for something to happen. What is better is "expectant management" of a known prostate cancer.
Expectant management with curative intent, also called active surveillance, is the new way of looking at this prostate cancer option. Older men with smaller volumes of non-aggressive cancer can be watched very closely with PSA blood tests and exams.
The plan is to initiate curative treatments, such as surgery or radiation, if and when changes occur to suggest cancer growth and progression. This will allow many men that qualify to avoid the potential side effects of treatments, and limiting aggressive therapy to those men that truly need it. The key is patient selection -- to identify and select only those men who can benefit from expectant management and do not need treatment right away.
Related Topics: 10 Important Questions for Your Doctor, (WebMD Video) Two-Drug Chemo Winning Combo for Prostate Cancer
Technorati Tags: prostate cancer, PCa, cancer treatments, mens health
A 78-year-old man with heart disease and a few other problems was found to have a prostate cancer. Not a bad one, not a large one. Just an average run-of-the-mill prostate cancer. One that, chances are, will not kill him.
In fact, for many men who are older and may not be healthy, some prostate cancers will not be the cause of their passing (as I get older I think passing sounds better than death). I am sure if you have read enough you realize that most men diagnosed with prostate cancer do not die of it, they die with it.
Cardiovascular deaths are still the biggest killer of men. When talking to patients I like to bring up an old saying "If I do my job right, you won't die of prostate cancer, even if you still have it with you."
So who needs their prostate removed, radiation, hormone therapy or chemotherapy? Who gets to go home and do nothing but check a PSA and prostate exam a few times each year? This is the big question all urologists would like to answer.
In general, it comes down to this -- if it is felt that the prostate cancer will be significant in your expected lifetime, then it is a good idea to have it taken care of. There are almost 50,000 men who die of prostate cancer each year.
With that in mind, and taking into account the different aspects of the cancer and the individual, there are some instances where it is believed that doing nothing may be the best approach. There are some instances where we feel that any or all the treatments will be more hazardous than the cancer, or that the odds are good the patient will die of other causes before the cancer can become a problem.
So if you choose this non-treatment we used to call watchful waiting, what does that mean? First of all, watchful waiting is not a good phrase as it implies we are waiting for something to happen. What is better is "expectant management" of a known prostate cancer.
Expectant management with curative intent, also called active surveillance, is the new way of looking at this prostate cancer option. Older men with smaller volumes of non-aggressive cancer can be watched very closely with PSA blood tests and exams.
The plan is to initiate curative treatments, such as surgery or radiation, if and when changes occur to suggest cancer growth and progression. This will allow many men that qualify to avoid the potential side effects of treatments, and limiting aggressive therapy to those men that truly need it. The key is patient selection -- to identify and select only those men who can benefit from expectant management and do not need treatment right away.
Related Topics: 10 Important Questions for Your Doctor, (WebMD Video) Two-Drug Chemo Winning Combo for Prostate Cancer
Technorati Tags: prostate cancer, PCa, cancer treatments, mens health
9 Comments:
At what age should men be checked for prostate cancer?
im a 19 year old male, and for a long time ive thought I had somthing wrong with my genital area, but everytime ive seen a doctor they say im fine,
But just recently ive been getting constant pain in my testicals,
ive got stomache and adomen pains and i also have urinating problems at times, the only sign I havent had is bleeding while urinating,
I havent gone to the doctor coz im worried they will just say im fine again and i dont know,
if u can help me or give me some advice please email me,
war_machinebrian1988@hotmail.com
tnx brian.
at age of 92 years old what is the risk you thak by having Chemotherapy prostate
what is the side affect?
or is betar not to have at ?
and continu with the pills
thanks haim
Haim and others with questions:
Please post questions on our Urology message board.
I'm having a pain in my rectum (no joke here), feels like something is enlarged on left side. Any idea if this is related to prostate?
Discovering I had prostate cancer at the age of 47 was almost an accident and certainly not something that in any way I expected. I had no symptoms - none whatsoever. In layman's terms, everything seemed to work fine. So the discovery of prostate cancer was quite accidental. It seems I had gone to my doctor simply requesting a pill (propecia - a drug to reduce hair loss). She required I have a blood test, as this drug would have an effect on my PSA. Frankly, all that was greek to me...as I didn't know what PSA was and had never had it checked. I hated needles - had always said I was allergic to them - hence I avoided being stuck as much as I could. But on this day in November 2004 I decided to take the plunge - have my blood checked - and get the prescription.
Two days later I got a call while out of town saying that all the lab work was fine except that my PSA was a bit elevated - it was 4.58 and for someone my age that was high. My doctor referred me to a Urologist. The appointment was set.
Of course I had some concern, but after all, all the plumbing seem to work fine and I had no symptoms, so surely there was no problem. The Urologist's exam was routine - in fact he said he thought I had nothing to worry about as he felt nothing abnormal. But, to be on the safe side he schedule a biopsy. Being fearful of needles (and a biopsy is the ultimate needle) I asked if it would hurt. His response, "Most men don't really feel a thing." That was a lie! Looking back, I would have asked for good drugs as that was the most painful experience I can recall.
Several days following the biopsy I received the results. Prostate Cancer! I had a Gleason score of 6 and 30% of one side of my prostate was cancerous. My heart sank as I received the news. How could I, a 47 year old healthy male, with no other medical issues have prostate cancer? And, how amazing that it was caught by a simple test that my well versed female doctor required. Looking back, her diligence saved my life.
What next?
My local doctor wanted to schedule surgery immediately. He said I had four options: (1) Radical prostotectemy (traditional surgery); (2) Radiation; (3) Hormone therapy and/or (4) Watch and wait. Again, he recommended surgery. My immediate question was how many of the surgeries that he was suggesting did he do weekly or monthly. The number was low. In the back of my mind I thought, "Hum, maybe I need someone who isn't so surgery happy and who does this delicate removal frequently." I was like learning to play golf - I would prefer to learn from someone who plays daily than learn from a weekend hacker. Maybe that analogy seems harsh, but after all the decision made would have lasting and profound effects.
Following the meeting with the Urologist, and after telling my family (who thought I was joking), I spent some time in research. First thing I found - based on my diagnosis - I had time to consider carefully my options. Not that nothing should be done, but I didn't have to rush into any hasty decisions. Prostate cancer generally is slow in it's progression. CAUTION - do not use my experience as a crutch to avoid treatment (I witnessed my father-in-law die from complications from prostate cancer), rather, seek competent medical help in making your treatment decisions.
Options Considered:
Watch and wait. Well for several months I did just that. I researched - changed my diet - considered the possibility that I could reverse what existed and even reduce the cancer. I began a regiment of daily intake of cottage cheese and flax seed oil. For a short time I actually saw a decrease in my PSA; however, that was short lived. What I did learn was that diet was important - not only for general well being - but an effective tool in promoting a cancer free body. This was valuable time in that it gave me the opportunity to consider all my options.
Radiation Therapy. Not really an option for me. While I talked with a man in his late 60's to early 70's who had outstanding results using focused radiation (proton therapy I think it was called), the reality is - once you opt for radiation and the tissue is destroyed, if prostate cancer returns, it cannot be surgically removed. Hence the best advice I received was, in my case, this would not be a practical option. By the way information on proton treatment can be found at http://www.protons.com/ or at http://www.llu.edu/. The people I talked with who had used this treatment were extremely pleased with the level of care they received and the overall outcome.
High Intensity Focused Ultrasound (HIFU). In my search for the right treatment, I spent much time in considering this alternative. There were three practical objectives I wished to accomplish with whatever treatment I selected: (1) Cancer elimination, (2) Minimal issues with incontinence (preferably none) and (3) minimal issues with erectile function (again, preferably none). Based on my Gleason score and prostate cancer diagnosis, it seemed that this treatment would be viable. For research information visit http://www.ushifu.com/. As part of my consideration I met with Dr. George Suarez, Medical Director for USHifu. He reviewed my medical background and was kind in taking the time to discuss with me my options using this new prostate cancer treatment. Dr. Suarez took the time to explain all my options and how, if I elected, HIFU could be effective while meeting my three objectives. My only resistance was, at the time, it was not an option yet approved by the FDA in the United States, hence I would have to seek the treatment outside the scope of my medical insurance outside of the country. While I gave this serious consideration, I ultimately decided to go another route.
Radical Prostatectomy. All of the possibilities above, brought me back to the original suggestion - SURGERY. The issue I had was what kind and who would perform it. Since I had the time to research I discovered (through the wonder of the Internet) this, then, new procedure called a robotic-assisted radical prostatectomy. Hum...seemed that needed more study. Of course, at the time, Johns Hopkins Brady Urological Institute was recognized as one of the best in the world for prostate cancer research and study. After careful consideration I contacted Johns Hopkins inquiring about this seemingly new procedure - using the daVinci Surgical System. www.urology.jhu.edu/MIS/daVinci/
The folks at Johns Hopkins could not have been more caring and helpful as I sought all my treatment options. Of course, they reviewed my file carefully and spent all the time I wanted and needed to evaluate my options. Dr. Li-Ming Su was my surgeon and my hat is off to him and his skill and patience. In the end, one thing was clear - all other options being equal - surgical removal was still the "gold standard" in the fight against prostate cancer. Likewise, it appeared that this robotic assisted laparoscopic radical prostatectomy would meet my three objectives.
The surgery went fine - of course I don't remember a thing - so all I can base it on what the Doctor's report. Initially the report indicated that the cancer was contained in the prostate and the removal should yield me "cancer free." Of course this was to be confirmed later from lab reports. The first several days following surgery were not pleasant, but tolerable. Within three days, I boarded a plane and flew home to North Carolina - travel was not a big issue. The most discomforting thing following surgery was the catheter - which remained in for three weeks.
Outcome. Within four weeks following surgery I boarded a plane to Dallas, TX to begin a new job. My energy level was back and I had minimal incontinence isses with subsided within another three weeks. Within seven weeks of surgery incontinence was not an issue. Erecticle function returned within three months (with the aid of medication) and returned to full function (without medication) within twelve months.
Now it's been two years since surgery and all three objective have been achieved. Life is normal. I am cancer free. My sincere thanks to all who were there for me as I sought out the treatment that was right for me. I would not have the opportunity to function as a motivational speaker today if it were not for the skill and help of the fine folks at Johns Hopkins. While printing such personal items for all to read may seem (to some) out there! I feel that, perhaps, others who find themselves diagnosed with prostate cancer may learn from my experience. If you find this helpful, but still need to talk - please visit my web site: http://www.chuckgallagher.com/ and contact me through that portal. I'll be happy to talk with you via e-mail or phone.
I had my Prostate Cancer cured at Loma Linda Proton Therapy Center in Loma Linda, CA with no side effects. I recommend it for anyone with prostate Cancer.
John Pomeroy
Tucson, AZ jcpomeroy@yahoo.com
I give anesthesia for surgery, and I saw my first radical prostatectomy some 25 years ago. I thought at the time that I would never would submit to that process.
It was very different though when at age 57 I heard that it was me who had PC and might need to have the surgery. I seriously considered all the options, and came up with this conclusion...not every treatment is right for every patient. People who are terrified by the diagnosis and feel that they must "get it out" of their bodies probably will choose surgery. Others with small tumors could choose any of the options and probably do well with it. But for those of us with larger tumors, or big bellies, probably only protons or surgery are truly available, as was my case.
And it is errant thinking, despite whatever you may hear from anyone, to think that any one treatment will offer a better chance than any other of total removal of cancer from your body. There's always the possibility that cells from the tumor or the cancer process have spread to other areas of your body before any treatment regimen has begun, and they may be so small as to be undetectable by any means.
Then there is the issue of side effects. ALL major methods of treating Prostate Cancer have roughly the same efficacy; that is, they are equally effective at eliminating the cancer, and have roughly equal recurrence rates. Where they differ is in their side effects.
For me, surgery was virtually (greater than 95% chance) guaranteed to make me impotent and somewhat (up to 25% chance) likely to make me incontinent (unable to control urine). Less than one in 20 that I would be able to have an erection and as much as 1 in 4 that I'd be incontinent didn't sound good to me. My surgeon's comment that if I couldn't get a natural erection Viagra might help, and if I continued to be incontinent after a year or two we might consider implanting an artificial sphincter to control my bladder was not well received. (Another surgery, and not guaranteed to work, at that!)
With that in mind, I based my choice on potential complications. With that as my criteria, protons ranked high above any other form of treatment.
I opted for protons therapy at Loma Linda University Medical Center and completed treatment in March of 2007. While there, I met many others undergoing treatment and can truthfully state that every one of us was having a great time...golf, sightseeing, exercising, all the entertainment that the LA-Palm Springs area could afford. I met no one who was having any worse side effect than being a bit tired in the last half of treatment, or some urgency to urinate also in the last half of treatment. We all talked about it all the time, so I don't think I missed anything.
The upshot is, if all the important measurements of success are equal in treating the cancer, why would anyone not consider using the side effects as the major reason to choose one method of treatment over another?
I believe if given a true picture of the process, most patients would opt for protons, hands down. I am truly happy for those who have had a good outcome from whatever option they chose, but the numbers favor protons.
Larry Matthews
lematt52849@gmail.com
Here I am at age 79 and I found that after prostate removal 15 years ago that the doctor assured men was well contained within the prostate, it has returned after a psa reading of 28 ! I am now told that LUPRON is the correct treatment. Well if it can control it for another 15 years who cares !
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