The following is a a guest entry I wrote for KevinMD, one of America’s top ten leading medical blogs. It ran this morning.
As a patient, I feel for anyone who is given a diagnosis of prostate cancer. Hearing the “Big-C” word can be upsetting enough. But the complexity of the disease—diagnosing it, trying to characterize it and selecting the appropriate treatment—can feel like insult upon injury. We need to talk about prostate cancers. With 24 known sub-types of this cancer—from non-life-threatening to very aggressive—it’s no wonder so much time is expended on debating PSA screening and the potential for overtreatment.
While debates continue, more than 32,000 American men die from this disease each year, placing it on par with breast cancer in incidence and mortality.
Oddly, I still contend that when I was diagnosed last year, I was “lucky” enough to have clear diagnostic and prognostic data to inform my decision to have a radical prostatectomy, despite potential side effects . My PSA had nearly doubled in a year’s time. As my urologist reviewed my biopsy results, the extent of the cancer’s involvement in my walnut-sized gland and my Gleason scores, I knew where I was headed. He dutifully began sketching out all treatment options currently available to patients when I told him to stop and move to the top two options. He gave me a dubious look before I shared with him that I had learned much about the disease in two years of working at the Prostate Cancer Foundation.
I was lucky once again when my surgeon’s professional instincts prompted him to remove some of my lower lymph nodes during my robotic procedure, something that’s not always done. The post-surgical pathology report upgraded my diagnosis to Stage 4 metastatic disease with single Gleason 5 cells discovered in the nodes. (Not exactly the kind of upgrades I am accustomed to in my life…) As a result, I headed into seven weeks of radiation therapy and three years of androgen deprivation therapy—a palliative treatment that drastically cuts my production of testosterone, a fuel for prostate cancer growth and proliferation. Today, I have a 60 percent chance that I will have to live with recurrent disease. I look forward without second guessing.
Not all patients have such clarity. Through My New York Minute, I meet many readers who are confused by the complexity of this disease. As a fellow patient who also works for world’s leading private accelerator of prostate cancer research, I remind them:
- The PSA test is not a cancer test—it’s a diagnostic tool for identifying potential problems, including cancer, in the prostate
- With 24 sub-types of this cancer, one size does not fit all for treatment
- Sometimes, the best treatment is no treatment and proactive surveillance
- Age and personal preference are important factors in treatment selection
- Once committed to a treatment plan, avoid the pitfall of second guessing
Science will someday, sooner than later, enable us to identify which prostate cancer a patient has and prescribe highly personalized treatments that will work best for their case. Until then, an in-depth understanding of the disease and the advice of a trusted healthcare professional remain the best tools for making treatment decisions with confidence.