Prostate Cancer & a­­ Game Plan

          When you are facing a prostate cancer diagnosis, you need a game plan. Often no surgery or treatment is immediately necessary if it is the low risk type. However, you must work with your doctors and get “active surveillance”.

Some background about prostate cancer and available treatment:
·         Cancer cells are developing in the prostate in the majority of men as they become elderly.
·         Some prostate cancer cells never grow fast enough to spread outside of the capsule. 
·         Erectile dysfunction is reported in 75%  of men treated with surgery or external radiation, but many older men may already have ED problems; meds and other treatment for ED are available.
·         Bladder control problems occur, especially after surgery during the first few years, worse while exercising.
·         Bowel problems occur more with radiation than with surgery.
·         Adverse effects from surgery often show up early but those from radiation treatment show up later


     If you have the low risk type of prostate cancer, you might have the option to just observe it without jumping into treatment. But you have to think about is whether you would worry excessively if you knew you had cancer cells that were not being treated. On the other hand, how would you feel if you had complications from treatment? Would you wonder if you jumped into a treatment too soon, if needed at all?

If you choose surgery, you have a 98% chance of being cancer free and according to surveys, the vast majority are happy and would choose this same treatment. Is this the best choice in all cases and does it need to be done immediately?


Please do not try to make the decision for what you would do based on this article or other readings without discussing with your doctor. Guidelines change as new studies are done and any slight misunderstanding could be deadly!
You probably discovered your prostate issue from a screening PSA (prostate-specific antigen) blood test or a rectal exam. Typically there are no early symptoms.
Talk to your doctor about your family history and other risk factors and do screening for prostate cancer at the appropriate age (40 y.o.?, 50 y.o ?)   If the PSA test is high, then typically antibiotics are used and the test is repeated to see if it is just an infection. Know your PSA numbers to see if it is over 2.5 or is rising more than 0.35 per year. Sometimes repeat testing is done months apart to see if there is a steady upward trend. If a biopsy is indicated, then the urologist will arrange to do this simple procedure in the office.  If cancer cells show up, the report will show if the cells are highly aggressive (Gleason score like 7) or less aggressive like 6. Also it states how much of the specimen showed cancer.
Very low risk  and low risk category patients are offered treatment with surgery or radiation if their overall health suggests they would live for decades. However observation is an option. These categories have Gleason 6  or less, and PSA <10. Very low risk has limited cancer tissue (<2 core positives, <50%)
Intermediate risk and high risk are usually those with Gleason 7 or more, or a PSA >10. In intermediate risk, it is advisable to be treated if you are considered healthy enough to live over 20 years.

Observation is not burying your head in the sand (or elsewhere).
It involves “active surveillance” with scheduled follow-up of PSA blood tests and biopsies over months and years when needed.
With such a game plan you might be one of the many who can safely avoid surgery or radiation treatment. Without a plan with your doctor, you might be blindly going down a road that could involve much more complicated risks and even death. In one study for 8 years, 99% of those in active surveillance are alive; only 1 in 4 needed treatment. One promising treatment being tested is an ultrasound treatment called HIFU.
On the web: nccn.org, cancer.gov  , FamilyDoctor.org (patient information by the American Academy of Family Physicians -August 2011 update)