Recently, on routine physical exam, my internist found my PSA had increased from 2.3 to 4.4. He sent me to a urologist who biopsied my prostate with 12 needles and found prostate cancer in four. He said I have Gleason score 4+3=7. He also said my prostate felt normal on examination. The word cancer scares us very much. And we don’t know what to do. We have talked to several doctors, been on the internet and we are so confused. My husband’s urologist said there are lots of different ways to treat prostate cancer but the best treatment is surgery (Radical Prostatectomy) with the robot. We then saw a radiation oncologist who told us that my husband could be treated just as well with IMRT beam radiation. Another radiation oncologist said that the best treatment would be beam radiation followed by seeds. We searched the internet and found other treatments such as proton beam and freezing the prostate (cryosurgery). All of this is confusing – one doctor says this, another says that. I want my husband cured. How do we find the best treatment?
A: Men newly diagnosed with prostate cancer and their families are typically confused because there is so much information, most of it misleading, about this disease, especially about the various treatments. However, you are doing the single most important thing to clear this confusion which is your own research – your own homework: talking to doctors, using the internet and reading about prostate cancer. But, instead of focusing on treatment which is what you are doing and what doctors focus on, I suggest you first get a basic understanding of prostate cancer, especially about your particular case of prostate cancer, and learn what PSA is needed after treatment for cure. If you do this, you can get rid of just about all your confusion. And it’s easy to learn about this disease.
A: Prostate cancer has the widest range of growth of any of the major cancers. It can be so slow growing that it will never bother a man during his natural lifespan or it can be extremely fast growing (or malignant) and cause a man’s death within 1-2 years. Of course, it can be anywhere between these two extremes. So, you should understand this disease and what kind of cancer you have, or in other words, how bad is your particular cancer.
A: No. You have plenty of time, weeks even months, to learn about this disease even with the fast growing type. The worst thing you can do is panic, have the wrong treatment or use the wrong doctor and not be cured when you could have been. And this is very important: with few exceptions, you will get one chance for cure.
A: Most doctors recommend the treatment that they perform. These are typically doctors who do not keep up with their patients, do not have a database and, thus, do not know what happens to their patients after treatment – whether or not they are cured or anything about complications. Because of this, you need to know how to ask the hard questions of doctors to find out if they really understand their recommendation and can give you the best chance of cure.
A: We run one of the largest and oldest treatment programs for prostate cancer in the United States – a program that was started in 1977. Since then, we have treated more than 16,000 men with irradiation for prostate cancer which is comparable in size to the Radical Prostatectomy program at Johns Hopkins where surgery was initially developed. They have one of the largest surgical databases in the U.S. along with RCOG’s. But, much more importantly, we have kept up with all of these men after treatment. Because of this, we have one of the largest databases in the country on prostate cancer. Our longest active follow up patient has a zero PSA 32 years since we treated him. From this database, we have written 76 peer-reviewed research papers on prostate cancer that have been either published or presented at major medical meetings in the United States. Our last published research paper documented the 25-year results from our program. In other words, we have as much experience as anyone in this country and a lot more than most doctors.