When detected in its early stages prostate cancer CAN be cured with a minimum of adverse side effects to the patient. The key to a proper cure is EARLY DETECTION!!!
A P.S.A. test will detect the quantity of Prostate Specific Antigen in the blood stream and this simple test should be used to detect the first sign of an impending problem.It is important to realize that the PSA test (using test methods currently employed) is accurate to +/- 30% and that these results can vary between labs and even within the same lab at different times. There are also other factors which may contribute to higher than normal PSA readings and these may have nothing to do with prostate cancer. So - the PSA test should be considered a warning sign which indicates that ADDITIONAL confirmatory tests are needed.
Once an initial PSA test indicates the possibility of prostate cancer the first confirmatory test should be an ultrasound coupled with a biopsy. Examination of the ultrasound results and the microscopic examination of the biopsy slides is completed, a Board Certified Urologist can then make an accurate determination regarding both the quantitative concentration of cancer cells and their physical nature. Once this information had been determined the prostate cancer in question can be given its full and proper identification. This will include P.S.A, Gleason Number, and TNM Classification. The Urologist will now be in a position to explain the significance of the test results and suggest possible methods of treatment. It is important to realize that Urologists are surgeons and may opt for a form of treatment which they are more comfortable.
PLANNING FUTURE ACTION:
With the "First Name, Middle Name, and Last Name" (PSA, Gleason, TNM) of the cancer properly identified, the patient is now in a position to do independent research of the literature on his own.
Suggested readings are: "The Prostate - A Guide for Men and the Women Who Love Them" By Patrick C. Walsh M.D. and Janet Farrar Worthington. Johns Hopkins University Press.
A Johns Hopkins Health Book.,"Prostate Cancer: A Non-Surgical Perspective" by Kent Wallner M.D., Smart Medicine Press, Canaan, N.Y. and "Man to Man" - Surviving Prostate Cancer, by Michael Korda, Random House Press.
The latter is a first hand account written by one patient who underwent surgery. There are many other books on this subject which are available in a comprehensive bookstore. I found the ones I have suggested are adequate to provide a base of knowledge to make an informed decision.
I was comfortable enough to devote over two years to "watchful waiting" and study of the problem. Not all men will be emotionally able to do this. If "watchful waiting" is something you can live with, it should be done only with periodic monitoring of the PSA as directed by a Board Certified Urologist or Radiologist.
I spent a considerable amount of time studying the problem. I have tried to summarize the facts and have indicated the location of supporting literature. A reader of this book could probably make an intelligent decision concerning a treatment procedure in less than two months.
Having now established the parameters of the cancer and with increased knowledge of various methods of treatment the patient would now be well advised to consult an additional source of professional information. The Urologist has offered his suggestions and the opinion of a Board Certified Radiologist should now be sought out.
In my personal and nonprofessional opinion, the patient should consider IMRT. Since there is a considerable learning curve required by the facility using this technique, it would seem reasonable to restrict the selection of possible facilities to these which have performed at least 500 such treatments.
Armed with an accurate description of his disease, fortified with as much technical knowledge as he can absorb, and having opinions from practitioners of both surgery and radiation, the patient is now in a position to make an informed and knowledgeable decision.
The treatment of each patient is individualistic and the response of one patient may not duplicate the response, or reaction, of another. That decision may involve "watchful waiting", surgery, or radiation as well as one of the several other forms of treatment which are available.
It is VITAL that the patient select the BEST POSSIBLE TREATMENT for HIS case "UP FRONT".
Medical procedures to recover from failed attempts to cure prostate cancer are called "salvage therapy" and may generate many additional and unwanted problems. The success rate of salvage therapy is usually much lower than choosing the proper treatment INITIALLY.
It is important to realize that prostate cancer is a very slow growing cancer and there is usually no need for rash decisions - particularly involving early detection of low order cancers.
During the period of "watchful waiting" the patient, under the proper medical supervision, can determine the "velocity" of his disease to see how rapidly it is progressing. In my own case I opted for two years of "watchful waiting", two years of evaluation of medical procedures combined with additional testing and a final treatment fully five years after the initial cancer cells were detected and rated at a PSA of 7.5.
Considering the rapid development of medical treatment of this disease, my choice of response to my disease was a fortuitous one. The IMRT method I chose was first being offered at the time I began my "watchful waiting". During the next five years the procedure was refined and developed further as additional test and treatment data was developed - especially concerning the advantages of Androgen Ablation and higher levels of radiation which could be administered as a result of the greater wealth of experience at the treatment facility. "watchful waiting" - if possible - therefore offers the possibility of improved treatment at a later time.
THE PRIME OBJECTIVE:
The PRIMARY and ONLY OBJECTIVE of treatment must be the CURE of the cancer, or forcing it into REMISSION, WITH A MINIMUM OF ADVERSE REACTIONS TO THE BODY. The objective is NOT to find the quickest or most convenient medical procedure or one that will "get rid of my cancer the quickest". Cancer CURE with MINIMUM collateral damage is the PRIME OBJECTIVE! The patient should insist that all physicians involved in his treatment be BOARD CERTIFIED.
DURATION OF TREATMENT is not as important as the PRIMARY OBJECTIVE.
The quickest form of treatment may not always be the best for a specific patient.It is true that there may be certain mitigating circumstances such as interference with employment which enter into this decision. However, if at all possible, the PRIMARY OBJECTIVE should be kept in mind. Many of the forms of treatment, of shorter initial duration, may offer the possibility of adverse side effects which will continue for years and the treatment itself may incapacitate the patient for some time.
CONVENIENCE of treatment is of much less importance than the Primary Objective. The inconvenience of traveling a long distance, or perhaps staying in a strange city during treatment will be forgotten soon enough. The CURE will last the rest of the patient's life. He will live with the presence or absence of negative side effects for years and perhaps the rest of his life.