There are many resources are available for men with prostate cancer, but the topic is difficult for them to discuss. Many men do not get the best treatment for their cancer because they do not act early enough. In 2008, there were an estimated 186,320 new cases of prostate cancer in the United States. About 28,660 men are estimated to have died of this disease. (source: American Cancer Society)
But there is hope. More cancers are caught early and new treatments are making it possible for men to live long and healthy lives following their diagnosis. By taking a few simple steps, men diagnosed with prostate cancer can take charge of their lives and overcome much of the fear and anxiety that accompany a cancer diagnosis.
So, even if you have recently been diagnosed with prostate cancer, take heart. You will have many decisions to make, but you will have plenty of company. Ultimately, there is a good chance your cancer will be cured or controlled. Most men die with, not of, prostate cancer.
What Is the Prostate?
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Located between the bowel and the bladder, the prostate gland is an essential part of a man's sexual organs, helping to create semen. It surrounds the first section of the urethra, the tube that carries urine from the bladder to the penis.
Understanding Your PSA
The most important test for monitoring the status of prostate cancer is the PSA blood test. The PSA test measures the amount of a protein, the prostate-specific antigen, circulating in the blood. Though present in small amounts in men who do not have cancer, the quantity of PSA generally rises when prostate cancer occurs.
A man with a healthy prostate typically has a PSA of 4.0 or less; but, even if the value of your PSA is higher, it may not mean that you have cancer. Your physician will order further tests to confirm or rule out the diagnosis. If cancer is detected, the PSA level is a valuable tool for monitoring the response to treatment and the spread of cancer.
When Cancer Is Found
The introduction of the PSA test in conjunction with annual digital rectal exams (DRE) have made early diagnosis the norm. This greatly increases the chances of treating prostate cancer effectively.
If your doctor suspects from the PSA test or a suspicious digital rectal exam that you may have prostate cancer, he or she may suggest having a biopsy. The biopsy yields multiple tissue samples which are checked for cancer. If the biopsy reveals that cancer is present, it is given a Gleason score, which is a measure of the aggressiveness of the cancer. The physician "stages" it to determine its spread, using imaging techniques such as ultrasound, bone scans, computer tomography (CT) scans, and magnetic resonance imaging (MRI) scans. Keep in mind that staging tests often underestimate the extent of prostate cancer, so unless you've already had surgery no doctor can tell you with certainty whether or not your cancer is limited to the prostate. For cancers of each stage, there are numerous treatment options.
Choosing a Therapy
Choosing a treatment for prostate cancer is not easy. The primary choices include surgery, radiation and hormone therapy, and cryoablation, which are used alone or in combination. Urologists usually specialize in surgery and cryoablation; radiation oncologists in radiation, both internal and external. Each group may advocate the treatment in which they have received training. What's more, there are published studies that seem to favor each type of treatment, including no immediate treatment other than careful observation for some older men.
The treatments can have side effects. Surgery, cryoablation, and radiation can result in impotence and incontinence. Hormonal therapy, which reduces the amount of testosterone in the bloodstream and thereby deprives a prostate tumor of a necessary stimulus, has been shown in clinical trials to extend life and delay time to disease progression. Side effects are usually loss of sex drive and weight gain. But hormonal therapy nearly always stops working after a time because tumor cells develop that are not dependent on the hormones. The potential consequences of treatment have to be weighed carefully in each case to determine the optimal approach.
Frightening as it is to remain in doubt and difficult as it may be under the restrictions of managed care, it is best to hear more than one opinion before deciding on a course of treatment. While it is advisable to receive treatment without great delay, there is almost always time to examine the options, including investigational therapies. If you decide to use any alternative of complementary approaches, discuss these with your physician as they can interact with other treatements.
Here are some guiding principles to help you:
- Insist on a second opinion.
- Get as much information as possible from books, support groups and the Internet (since this information may not always be accurate, unbiased, or applicable to your situation, be sure to check with your doctor before following medical advice you read about)
- Take along a detailed list of questions and record the answers.
- Ask about your doctor's experience in treating prostate cancer.
- Take along your wife or a friend who can act as your advocate.
- Make sure you and your doctors treat the whole patient, not just the prostate.
Investigational Treatments
There are several new and promising experimental treatments for prostate cancer that may offer improved outcomes. Hundreds of clinical trials are now testing them. You may be eligible for such a treatment, depending on your cancer. For more information about clinical trials contact the National Cancer Institute at 1-800-4CANCER and the National Prostate Cancer Coalition toll-free at (888) 245-9455.
Promising experimental treatments include:
- Neoadjuvant hormonal therapy, which shrinks the prostate tumor to increase success rates of surgery or radiation,
- Immunotherapy, which boosts the body's own defenses against cancer.
- Chemotherapy, using new drugs that might help men with advanced prostate cancer.
Many studies are ongoing to determine if men with late-stage cancer can benefit from immunotherapies. In the future, such therapies also may be used to prevent recurrence of cancer following initial surgery or radiation therapy.
Learn More About Prostate Cancer
Books
- The Patient's Guide to Prostate Cancer, Marc Garnick, M.D. (Plume, 1996, $11.95)
- Man to Man: Surviving Prostate Cancer, Michael Korda (Random House, 1996, $20)
- The Prostate Book, Stephen N. Rous, M.D. (Norton, 1994, $12)
- Solving Prostate Problems, Martin Gelbard, M.D. (Fireside, 1995, $12)
Support Groups
- Us Too! 1-800-808-7866
- American Cancer Society "Man-to-Man" 1-800-ACS-2345
Web Sites
This information is not intended as a substitute for the medical advice of your physician. Consult your doctor regularly about matters concerning your health, particularly regarding symptoms that require diagnosis or immediate medical attention.