Living Well

February 1, 2010

Prostate Cancer: Mission Guided Consultation

My sister is a health sciences educator at a Midwestern university.  On an early test in one course, she asks, “Who is responsible for your health care?’  It is a multiple choice question with answers like the insurance companies, doctors, etc.  The correct answer is YOU.  You are personally responsible for your health care and understanding what is happening.  This may not have been the case in an earlier time (and still is for many senior adults because they do not understand nor question authority), but you are responsible for what happens in a prostate cancer journey and consultation.  If prostate cancer is your journey, you will have to make some decisions along the way.

My own consultation took three hours.  Since I had already chosen a very good surgeon, this was a highly informative time together with me and my wife.  From the start, my advice is go prepared to ask many questions AND to stop the surgeon along the way and ask more questions.  If you want to live well, you have to ask the right questions in the process.

As I write this blog, I am looking at five yellow legal size pages of notes given to me by my doctor after the consultation.  It contains very rough drawings, types of treatments, side effects, and many other items to help me make a good decision about my treatment.  These are the history of that three hour consultation and the reminder of the choices I would have to make along the way.

I was 53 when diagnosed with prostate cancer at Gleason 7.  This age and Gleason Score changes the options often available for younger men that older men have available to them.  After we discussed the biopsy results, we began examining the options for treatment.  At 53, the goal was cure.  At 83, the goal may be to retard the growth of the cancer.  But for a young man, the goal is cure by the types of procedures.  If the cancer is slow growing, early stage, then one option might be the best.  But if fast growing with a high Gleason Score, many options might be taken off the table.  A good article concerning this appeared in the New England Journal of Medicine (Winter 2008).

Drawing a hierarchy of treatments, my surgeon explained six of them to my wife and me.  There may be more that you read about, but these are the typical treatments to choose from.  In the hierarchy, “watchful waiting” was at the bottom because of the Gleason Score and my age.  Both were against me.  Next was a series of chemical injections.  Again, this put time against me as this takes a number of injections to see results.  Fourth on the list was hormone therapy.  This can be a good option for older men with slow growing prostate cancer or early stage.  Hormone therapy retards the growth of the cancer.   These were treatments 6 through 4.  These treatments are not cures.  They are means to control prostate cancer.   Here I say emphatically:  You MUST consider your age in treatment AND you must ASK your doctor all the risks and side effects of each of these treatments.  EVERY treatment does have a side effect from impotence to incontinence to breast tissue enlargement (hormone therapy) that you must be aware of before you make a final decision.

 For me the goal was cure.  Cure treatments would allow me to live well.  Cure treatments also have their side effects, but would allow me to still life a full life.  In a previous blog, I talked about my personal mission and how it guided me in this particular choice.  Additionally, I had a trip planned for Egypt.  I had tried for 8 years to get to this country that I taught about every year at my University.  But because of so many circumstances, I could not get there.  I wanted a cure—one that would give me life and allow me to live this dream of touring archaeological sites in Egypt.

Curing prostate cancer is never 100%.  As I know intellectually and my doctor reminds me in the ongoing blood tests, “It only takes one cell to get away and multiply again; so we work at cure and ongoing monitoring.”  THIS is the life long journey started with prostate cancer, as with any cancer.  For me the options for ‘cure’ were freezing the prostate with liquid nitrogen, radiation, or prostatectomy.   Freezing may be a good option, but does have some dangers associated with it.  While there are significant safeguards, if an area unintentionally gets frozen, it is destroyed; no turning back.  Radiation is a good cure, but again, age is a factor.  The return rate of cancer following radiation may be as much as 15% over 15 or so years.  Thus if you are 80, that is not a problem.  But if you are 50, that is a problem.  And if radiation is used, it burns up the prostate and the tissue around it.  In essence, as my surgeon said, your prostate is like a charbroiled brisket.  If the cancer would return, there is nothing to surgically remove or radiate again.  You may be faced with chemotherapy as the only option.  The final option for me was surgery, a prostatectomy.  The cure rate is approximately 93%; remember nothing is 100%.  This is the cure treatment I chose, again because I want to live long and well.  There was a good deal of life remaining for one seeing the future from age 53.  I will explain this procedure in the next blog and the options related to it.      

So now, questions to know in the consultation or ask of yourself in the process:

  • What is my Gleason Score?  Is my cancer slow growing, early stage or fast growing?
  • What factor does my age play in the treatments for prostate cancer?
  • What are the side effects of each treatment offered to me?
  • What is the cure rate for each of the treatments offered me or are these treatments meant only to retard the cancer’s growth?
  • What is my goal in prostate cancer treatment related to my age and circumstances?
  • What is the percentage of reoccurrence of prostate cancer if I use this treatment option?
  • What does my wife need to know about these treatments or options?  What is she feeling about these cancer issues?
  • Finally, remember to ask questions, ask questions, and ask questions…..

 

 My personal mission and desire to live and live well helped me choose that option of a prostatectomy.  It allows me the best option for living a long life and growing old with my lovely wife.  While nothing guarantees anything, choosing this option from a place of being fully informed allows me the greatest potential to live as it is intended.

Blessings to all you men in the prostate cancer club who are currently faced with many decisions.  Make them well and with focus on life!  Grace and peace.

David Neidert

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