PROSTATE CANCER: SO WHAT DO I DO?

First, educate yourself. Learn everything important there is to know about your own cancer—your clinical stage, PSA level and Gleason score. Explore all your options—we’ve done our best to cover them all in this chapter, and specific forms of treatment are covered in greater detail in the next chapters. Get a second opinion, and a third if you need it, and talk to patients. If you can’t get some names from your doctor, call a prostate cancer support group (see “Where to Get Help,” at the back of this book) or another organization that specializes in prostate cancer. Be your own advocate, and take heart—there is much you can do to make sure you get the best treatment possible.

Say a man has a palpable tumor involving one entire lobe of the prostate (stage T2b, or Bi disease), a Gleason score of 7, and a PSA between 10 and 20. The likelihood that his tumor is confined to the prostate is 19 percent; the probability that his cancer has penetrated beyond the prostate wall is 81 percent. He has a 33 percent chance of having cancer in the seminal vesicles, and a 24 percent chance of lymph node involvement. What should this man do? Here, age plays a major role. Say this man is in his early fifties. Even though cure is not certain, it’s clear that if he does nothing he will probably die of his disease. Because the side effects of surgery are much milder in men this age, surgery is certainly a reasonable option, and it does offer the possibility of cure.

On the other hand, say he’s in his seventies. The question here is whether a man who may not live long enough to die of prostate cancer should be put through an operation with an uncertain likelihood of cure. Surgery has more side effects on people in their seventies. So, for this man, radiation therapy is a better, more reasonable option.

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