Taking Time for Treatment Decisions
Dear OncoLink "Ask The Experts,"
I have been diagnosed with prostate cancer, Gleason score of 6, PSA level of 6.4. How much time can I take to consider treatment options?
Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:
Although it may feel like an emergency, taking time to get a second opinion to consider your prostate cancer options is fine, and probably wise.
From the information you provided, you appear to have low-risk disease, in the sense that the risk of tumor being present beyond the capsule is small (less than 10%), the risk of an involved seminal vesicle is about 2%, and the risk of nodal involvement is <0.3%. The risk of progressing from an "early" tumor that can be treated with surgery, brachytherapy (radiation seeds), or external radiation alone, to a more "advanced" tumor that would require hormones, is <10% over 1 year. The risk of developing distant metastatic disease is about 5% per year.
I have cared for a number of low-risk patients whom I would first see in October and November and who were snowbirds, heading south in early December. They were seen for treatment recommendations and then given an appointment for early April to start, upon their return. I have never had a problem with a worsening in disease stage. Now, this length of time may be a problem in a more aggressive tumor with a higher Gleason score, but a few weeks is do-able in most cases, assuming there are no acute health issues (cord compression, severe pain, etc.).