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Your Guide to Making Prostate Cancer Treatment Decisions
by Steven Lamm, MD, Herbert Lepor, MD, and Dan Sperling, MD
Ultimately, you are responsible for your own healthcare. Your doctor is, of course, an important part of figuring out health problems and helping you treat them, but when it comes to decision making and following through on treatment and care, the buck stops with you.
A diagnosis of cancer is overwhelming, and it can be tempting to sit back in shock and let your doctor take control. But this is where your partnership is even more critical. Finding the right treatment for your prostate cancer isn’t about looking at cancer cells under a microscope and then applying a treatment algorithm. It’s about looking at you as a whole person – your family, job, likes and dislikes, habits, personality, culture – and then finding the treatment that will work best to maintain both your health and your happiness.
Talking to Your Doctor
Full disclosure and open communication are important when working with your doctor to treat your prostate cancer. That means frank discussion about your sexual performance and habits, your emotional well-being, and other potentially sensitive topics. Remember that the patient-doctor relationship is highly confidential, and having these conversations will lead to better care for you.
The best treatment for your cancer is one that will prolong your life without damaging your overall quality of life. This will be different for every man based on his personal circumstances and the specific characteristics of the prostate cancer itself. A full and frank discussion with your doctor is the best way to determine what course of treatment is right for you.
A Treatment Team
While a urologist typically diagnoses prostate cancer, your treatment may involve a number of other specialists, including a radiation oncologist, an interventional radiologist, and others. All the physicians involved with your prostate cancer care can and should coordinate treatment and records among themselves.
It’s important to let your urologist know about any other chronic health conditions for which you are being treated. Likewise, you should make sure your other doctors are aware that you are being treated for prostate cancer. Sometimes, treatment and medicines for one health condition can interact with those for another, so sharing your cancer care and health information is important.
It’s important that you are confident in your prostate cancer treatment decision. If you’re uncomfortable or still have questions after you’ve had a full consultation with a doctor, you need to get a second opinion for your own peace of mind. Realize that the second opinion may be different from the first, which might trigger the need to seek a third opinion. But at the end of the day, you need to be at peace with the decision you make.
Because different specialists focus on different types of prostate cancer treatment, it is helpful to visit different doctors to learn more about your options when you are not sure which path to take. For example, a urologic surgeon can offer the most insight into prostate surgery, a radiation oncologist can tell you all about radiation therapy, and an interventional radiologist can explain MRI and prostate ablation. Each of these specialists is very comfortable and confident in their own treatment protocol. The best-case scenario is to find a practice or prostate cancer center where these different specialists work collaboratively with one another to provide you with integrated care.
The “Art” of Prostate Cancer Treatment
Prostate cancer is unique in that there is almost as much “art” to appropriate diagnosis and treatment as there is science. The science tells us what types of cancers are more likely to be aggressive and what percentage of men may benefit from a certain kind of treatment. But it doesn’t give us the full picture of what the right choice is for you as an individual.
From screening to treatment, one size certainly does not fit all in prostate cancer. Every cancer is biologically different, and every man has different personal needs for treatment, based on his health, age, lifestyle, and emotional needs. Looking at all of these factors is the best way to determine what is right for you.
Finding Your Treatment Path
Treatment for prostate cancer runs the gamut from surgical removal to a “wait, watch, and see” approach of scheduled screenings and careful observation. To help determine the best treatment path for you as an individual, you and your doctor should consider the following:
♦ Age A 50-year-old man usually has very different personal and health needs than an 80-year-old man. For men in the very late years of life, surgery or other invasive treatments for prostate cancer will do little to prolong their lives and can instead cause harm.
♦ Health status If you have other serious health conditions, they should be taken into consideration when choosing your prostate cancer treatment. Your doctor should explain how your overall health would be affected by various treatment choices. For example, men with pre-existing bowel diseases such as ulcerative colitis, diverticulitis, or Crohn’s disease would be poor candidates for radiation therapy.
♦ Psychological impact Your emotional well-being is just as important as your physical health. Some men find it difficult to cope with a treatment path where cancer is left in the prostate and monitored. Others may have extreme anxiety and depression around the idea of sexual or urinary side effects from surgery. Minimizing stress around prostate cancer treatment is an important part of a person’s overall health.
♦ Individual needs and lifestyle Jobs, family dynamics, finances, sexual activity, personal passions – each of these should be taken into consideration when choosing an appropriate prostate cancer treatment. As you and your doctor discuss the side effects and outcomes of different treatments, think about how they would affect the way you actually live your life.
In an ideal world, your doctor would discuss all of these factors with you in detail to help guide your treatment choice. But with the time and scheduling pressures of the typical doctor’s office visit, things can get overlooked. Write a list of questions you have before the appointment and bring it along, with a pen to take notes. You may also want to bring a spouse or significant other as a second set of ears. And remember, in the vast majority of cases, there is no rush to come to a decision as you sit in your doctor’s office hearing your options for the first time. If you need time to contemplate your choices and discuss them with family, take it.
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Dr. Steven Lamm is the director of the Men’s Health Center at New York University’s Langone Medical Center in New York, NY, and a practicing internist. Dr. Herbert Lepor is the Martin Spatz Chairman of the Department of Urology and the director of the Smilow Comprehensive Prostate Cancer Center at NYU Langone Medical Center. Dr. Dan Sperling is the medical director at the Sperling Prostate Center in New York, NY.
Excerpted with permission from Redefining Prostate Cancer: An Innovative Guide to Diagnosis and Treatment by Steven Lamm, MD, Herbert Lepor, MD, and Dan Sperling, MD, © 2013 by Spry Publishing.
This article was published in Coping® with Cancer magazine, January/February 2014.
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