You?ve just been shocked with the pronouncement that you have prostate cancer. What should you do?? The first thing you want to do is ask questions. How aggressive is the cancer?? That?s the essential first question. Suppose you have but minimal cancer. Should you go for treatment or do nothing?? What are your doctor?s recommended options? That?s next.? And then?? Then it?s time to sort things out, and let?s be frank. It?s not easy to decide what to do.
It doesn?t help that many published studies offer conflicting and often confusing advice.? And it doesn?t help that the media may chime in and add to the confusion, by painting black and white pictures when generalities can?t be drawn.? In May, 2012, for instance the U.S. Preventive Services Task Force recommended against using the prostate specific antigen (PSA) blood test to spot the disease, arguing that screening leads to over treatment and unnecessary side effects (urinary incontinence and erectile dysfunction). Their recommendations led to an outcry from urologists throughout the country who faulted them on their trial procedures and conclusions.
The thrust of the task force argument was that doctors are aggressively over-treating men with minimal prostate cancer who need not be treated at all but merely observed over time and not be subjected to side effects. Critics say the recommendations left out those who are at high risk to prostate cancer, those with family histories of prostate cancer and as well as African Americans? all of whom should be screened for the disease. Also, they charge the task force lacked urologists and prostate cancer specialists.
Now, another U.S. funded study is out that is certain to fuel the debate over whether men are being over-treated or not. This study at the VA Health Cancer Center in Minneapolis reports that surgery for prostate cancer was no better in saving lives than observation ( Expectant Management?some call it ?wait and see?) over a 10 year period. ?The death rate from prostate cancer among the patients with lower PSA levels was the same regardless of whether patients got surgery or observation.?? In patients with higher PSA levels, surgery significantly reduced all deaths and prostate cancer deaths.
?So what?s the take-away?
When most men discover they have prostate cancer they are apt to say they want something done. The idea that some cancers are not life threatening is for some people hard to accept; they still want it removed. They are likely to think even minimal cancer will always be lethal. So, the vast majority of men will elect to have the surgery performed. They don?t want to take the risk regardless of side effects. ?The National Institutes of Health report that only 10 percent of men with minimal prostate cancer gamble it won?t kill them and will vote for observation. Countless men with minimal prostate cancer carry the disease throughout their lives with no ill effects. Unless we discover the fountain of youth what in the end can undo us can turn out to have nothing to do with the dreaded prostate cancer.
So the patient?s final decision whether to undergo surgery or not comes down to a very personal decision? often one that can be thought of as a toss of the coin.
Norman Morris
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