Most of the time, when you have an illness, either you have no choice about what’s going to happen to you (because, for example, you’re having a heart attack, and the only important thing is that someone does something — and pretty darned quickly at that!) or there are a very limited number of approved treatment options and it seems pretty obvious to you and your doctor how to proceed.
Prostate cancer is “different” — and big time!
If you haven’t already read the page titled, “ In the beginning …,” it might be a good idea if you did. Then you can come back here and continue with the next paragraph.
Back already, huh! OK. Let’s go …!
Basically, if you have been diagnosed with early stage (localized) prostate cancer — and in most of the developed world today, that is what you will very likely have been diagnosed with — you have a whole series of possible treatment options, as follows:
Established surgical treatments
Open radical retropubic prostatectomy (RRP)
Open radical perineal prostatectomy (RPP)
Minimally invasive (laparoscopic) radical prostatectomy (MIS or LRP)
Using “robot” assistance
Without “robot” assistance
Established radiotherapeutic treatments
External beam radiation therapy
Radioactive seed implantation (brachytherapy)
Less well established treatments
High intensity focused ultrasound
Worse still, it is highly likely that that you are an appropriate patient for at least 10 of the 13 options listed above!
Now, we deliberately didn’t given you any links to these options on this page because we want your undivided attention for just a minute or two. OK? So please stick with us:
Yes, you are going to have to choose between all of these various options that you may never have heard of before today!
Some men literally “freeze” when faced with this decision. If that happens to you, reach out for help to someone: your spouse, a friend, the Social Network, a prostate cancer support group, we don’t care who — but you need help and you need to ask for that help.
It gets worse because … there are no good data that will allow you to say, easily, “Oh, well obviously treatment X is way better than treatment Y.”
And … the physicians who are experienced in treatment of prostate cancer are biased by their training. Urologists are surgeons. All things being equal, they will always tend to recommend surgery. Same for radiation oncologists. They will always tend to recommend radiotherapy. This has been shown in actual studies! (We don’t have any data yet, but it’s a pretty safe bet that the experienced brachytherapists and ultrasound specialists now feel the same way about their areas of specialty!)
So what does this mean?
It means you are going to have to do one of two things:
You can either throw up your hands and do whatever some doctor tells you (which comes with a whole bunch of risks, not least that you just gave up responsibility for one of the most important decisions of your life) or
You can start to do some serious homework, which is likely to involve visits to at least one urologist, one external beam radiation specialist, and (maybe) one brachytherapist. And you may want to make more visits than that!
In the end, only you can decide what type of therapy “feels” right for you. You may feel that radiation is something you are more comfortable with than surgery. You may feel that surgery will be quicker and easier. You may decide that your risk for disease progression is small and you can “live with” the risk of progressive disease, so watchful waiting is right for you.
Where are you going to go to do that homework? If you have been diagnosed with early stage disease, you start here and then start talking to the doctors: