Tuesday 26/05/2020 - 05:31 am

Alleviating Fear on the Road to Prostate Cancer Treatment

2017.03.15 06:22

Receiving a prostate cancer diagnosis, no matter the "stage" of illness, can be an immediate shake-up to a mans physical and mental well-being and that of his loved ones. Being given such news can carry with it an uncertain timeline or prognosis, sometimes resulting in extreme worry and anxiety for men and their families. Its times like these when the difficulty of discussing treatment options can be compounded due to the interference of extreme, but understandable, emotion.

I have witnessed the initial reaction of many men after learning of their confirmed prostate cancer diagnosis, especially as we begin to discuss treatment options. From "watchful waiting" and cryotherapy to radiation and surgical treatment, there are a number of ways to approach prostate cancer treatment. Throughout my years of experience in treating urologic cancers, in many instances, men are hesitant to take surgical steps to treat prostate cancer for fear of potentially suffering significant changes, including sexual dysfunction and a concern over loss of masculinity. There is no doubt that such decisions are difficult, which is why we urologists use education, compassion and patience as our guides to help answer the difficult questions and provide the most effective answers.

As a physician, I know that no two prostate cancers are alike (just as the humans diagnosed with them are unique individuals), nor do they always progress in the same timespan or fashion. Unfortunately, there is no "one-size-fits-all" handbook on prostate cancer progression, and the time it takes to evolve from early stage to terminal cancer can be different from one man with the disease to the next. So my approach to the prostate cancer treatment discussion with patients and their loved ones is usually a multi-pronged approach.

When we discuss treatment options with patients, they usually fall into two categories: non-curative treatment and curative treatment. Non-curative treatment includes "watchful waiting" or hormone therapy. They are still classified as treatments, but they arent intended to cure or eliminate the cancer. Curative treatments, on the other hand – those that include radiation and surgical treatments – are administered with the goal of eliminating or surgically removing the cancer.

Its important to note that many men who are diagnosed with prostate cancer may be placed in active surveillance or "watchful waiting" without immediate need for any direct treatment at all. In these cases, the cancer may be very slow growing and therefore present a minimal threat to the patients life. Its important to remember that active surveillance is not the same as ignoring or forgetting that the cancer exists. This course of treatment will still require follow-up and testing to closely monitor the cancer and how it behaves over time. Men who are recommended this course of action will have prostate cancers that are:

    Low-stage: staging refers to how advanced the cancer is or how far it has grown.
    Low-grade: grading refers to the Gleason score of the prostate cancer, the lower the score, the more likely the cancer is to grow and spread slowly.
    Low-volume: this refers to how much volume a tumor of the prostate inhabits.

In cases where treatment is recommended, some men with relatively low-level cancers are good candidates for treatments like cryotherapy (freezing of the prostate) or radiation:

    Cryotherapy: performed by using very cold temperatures to freeze prostate cancer cells. This treatment is sometimes used to treat early-stage prostate cancer or as a treatment option after cancer has returned post-radiation therapy.
    Radiation: external radiation or Brachytherapy are used destroy prostate cancer cells using radiation beams. External radiation generates the beams from the outside to penetrate the inside of the body. Brachytherapy uses radioactive seeds that are implanted inside the patients body.

Understanding Surgical Prostate Cancer Options

In some cases, men with early-stage prostate cancer who have at least 5 to 10 years life expectancy were the cancer to be cured may be eligible for surgical removal of the cancer. For those men who are good candidates for prostatectomy (the surgical removal of the prostate), this procedure can be performed using a minimally invasive, nerve-sparing approach. When performed by a highly-trained, skilled and experienced urologic surgeon, many men can have the cancer successfully removed and their sexual function preserved, thereby giving them the best possible chance at curing the prostate cancer and preserving a high quality of life.

When it comes to any type of surgical procedure, there are certainly risks involved. However, its important to note that many of those risks are significantly reduced when minimally invasive surgical procedures are employed by surgeons who are qualified, experienced and whose results are excellent.

Ultimately, the decision is a very personal one.

As a medical community, we know that treatment in prostate cancers early stages is typically more successful than attempted treatment in its later stages. In order to make an informed choice, patients and their loved ones must have a complete understanding of the risks involved with all of the treatment options available to them. This is where choosing a physician you trust makes all the difference. The "right" physician will certainly be experienced and qualified. But he or she should also be someone who will take the time to help clearly guide the patient and family through all the possible options and their associated risks, in addition to identifying and addressing what is motivating the patients decision-making. With this information, and with the expertise of an experienced urologist, patients and their loved ones can obtain the information they need to make the best prostate cancer treatment decision – to prolong and maintain their quality of life.

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