Being diagnosed with prostate cancer can be frightening. The more you learn, however, the less anxious you may feel. Your most important task after being diagnosed is to get as much information as you can about your condition. Then you and your doctor can talk over the best course of action. Because there is an array of treatment options, making the decision can be complicated. Here are the key questions to ask:
How much time do I have to make a decision?
Thanks to early detection, most prostate cancers today are found in the very early stages. "Twenty years ago, about one-third of newly detected cancers were advanced or had spread to other parts of the body. Today those advanced cancers represent less than 2% of prostate cancers detected," says Peter Carroll, MD, chair of urology at the University of California, San Francisco. The vast majority of men diagnosed with prostate cancer, in other words, have plenty of time to make a considered decision about treatment. "Probably the single most important thing I tell patients is not to rush to a decision,” Carroll says. “Get educated. Ask lots of questions. Take your time.”
How aggressive is my cancer likely to be?
Although doctors are very good at detecting prostate cancer early, they have a tougher time distinguishing between slow-growing and aggressive forms of the disease. Most men past the age of 70 have cancerous cells in their prostate that would never pose a life-threatening risk. Today, by combining information from PSA tests, digital rectal exams, imaging studies such as ultrasounds, and biopsy results, doctors can make an informed evaluation of the risk that an individual’s prostate cancer poses. In assessing risk, doctors also consider age, ethnicity, and family history.
Does my age matter?
Age is an important consideration. When it occurs in younger men, prostate cancer is often less aggressive than the same disease diagnosed in older men. Age is also a factor in deciding on the best treatment. A man in their early 40s who still hopes to have children may be more concerned about the possible side effects of impotence from surgery or radiation than a man in their 70s. Thus they might opt for watchful waiting – monitoring the cancer and treating it only if it progresses.
What are the risks and benefits of my treatment options?
Prostate cancer can be treated in a variety of ways, including surgery, radiation, and medication. Even within these categories, researchers have developed a variety of techniques, including three different ways to perform surgery, two approaches to radiation therapy, and several drugs that suppress prostate cancer. “With so many choices, doctors can tailor treatment better than ever before,” says Howard I. Scher, MD, chief of genitourinary oncology at Memorial Sloan-Kettering Medical Center. But the range of treatments also means doctors and patients must weigh many factors. That’s why it’s crucial to talk to your doctor about the risks and benefits of all your options.
What about practical considerations of treatment?
Risks and benefits aren’t the only criteria for evaluating treatment options. There are also practical factors. Consider the choice of radiation therapy. One approach, called external beam radiation, requires going in for short treatments five days a week for 8 to 9 weeks of treatment. Radioactive seeds, by comparison, can be implanted in a simple surgical procedure that takes less than two hours. Some men would rather avoid surgery and opt for external radiation; others prefer the convenience of having radioactive seeds implanted during a single clinic visit. Talk to your doctor about what how each therapy is performed before you make your decision.
If I opt for watchful waiting, how often will I need to be monitored?
Active surveillance, also called “watchful waiting,” involves careful observation to detect any change in the cancer that would indicate it is progressing and requires more active treatment. Watchful waiting usually includes PSA tests every few months, periodic imaging studies, and repeat prostate biopsies.
Should I get a second opinion from a doctor who specializes in another approach?
Doctors who treat prostate cancer often specialize in a particular treatment approach, which inevitably influences what they recommend. A doctor who specializes in radiation oncology, for example, is likely to recommend radiation. A surgical oncologist will feel most comfortable recommending surgery. To get an unbiased view of all of your options, consider getting a second and even a third opinion before deciding on your treatment. If your doctor discourages you from getting another opinion, find another doctor.
After you’ve had an initial conversation with your doctor, there are questions that you should ask yourself. Because prostate cancer treatments can have an impact on sexual function and quality of life, it’s important to sit down to talk with your partner. Here’s what to consider:
Do I feel comfortable with my doctor?
Treatment of prostate cancer can be complicated. Even after treatment is completed, you will need follow-up care. You should feel confident that your doctor listens, understands, and provides you all the information you need. You should also have confidence in your doctor’s expertise. If you have doubts, find another doctor.
Do I understand everything I’ve been told?
Understanding your particular grade and stage of prostate cancer and making sense of complicated treatment options isn’t easy, especially at a time when you’re already under stress. If you don’t understand something your doctor has discussed with you, ask more questions. Search out reputable sources in books or on the Internet. The more you understand, the more comfortable you’ll feel with your treatment decisions.
What about my loved ones? How will my decision affect them?
A diagnosis of cancer affects everyone in the family. Close family members may have their own feelings about what you should or shouldn't do. Take their feelings into account. But remember: the most important consideration is ultimately what you want. Because treatment can affect sexual function and quality of life, discuss your choices with your partner. An open and honest discussion before making your choice will help you both cope with unwanted consequences of surgery or radiation.
How comfortable would I feel monitoring the cancer and waiting until I need treatment?
With early detection, watchful waiting has become the appropriate choice for a growing number of men. Some men are comfortable with the idea of waiting and watching. Others aren’t. "About one third of men who undergo treatment after beginning active surveillance do so not because the cancer has changed but because they don’t like living with the cancer,” says Carroll. In some cases, learning more about the tests that are used to monitor prostate cancer can help allay fears.
How do I feel about surgery versus radiation therapy?
In some cases, there may be strong reasons to choose surgery or radiation. Surgery is a good choice if the cancer hasn’t spread beyond the prostate and you’re in otherwise good health, for instance. Radiation may be a better choice if the cancer has spread or your health would make an operation risky. But in many cases either approach may work just as effectively. Then it becomes more important to weigh the risks and to think carefully about the approach you prefer. “It’s important to weigh all the options,” says Scher. “But ultimately the best choice is the one that you feel most comfortable with.”
