Okay, you received the bad news from your urologist – the biopsy that was performed on your enlarged prostate showed some cancer. Most of the time they will tell you – unless you have a high Gleason score and high PSA – that this is usually a slow-moving cancer that can be monitored and may be years before it may need you to take some sort of corrective action. The choices to do something that you may be facing are a bit scary, including: prostate removal (radical prostatectomy); radiation; chemo; and or hormone therapy. So doing nothing starts to look pretty good for the moment. But it may not be the right choice.
Doing nothing for now has the advantage of keeping your prostate, delaying the operation, putting off possible side-effects into the future, and continuing to have somewhat control over your urine flow and not dealing with impotence. However, here are the choices just in case:
Or you may wish to go part way proactively and consider radiation. This has the advantage of leaving you with your prostate and possibly killing off the cancer cells within it. It’s really nice to still have a prostate. It surrounds your main urinary sphincter valve, helping it to close when you want it to stay closed. (Woman don’t have this type of aid and therefore tend to make more bathroom stops.) The state-of-the-art for prostate radiation therapy has greatly improved in recent years. They have a gel that they can shield the surrounding tissues so that the radiation is mostly localized to the area being targeted. However, if the radiation for some reason does not work, the scarring done to the prostate and urethra by choosing this treatment would eliminate the chance of future prostate surgery.
Chemo would also allow you to keep your prostate. But the rest of your body may not be very happy with this choice. The poison may or may not work to kill all the cancer cells, especially if they have metastasized. Chemo will weaken your body, your immune system, possibly make you very ill, and may need to be repeated for years … if you survive it. This might be one approach to consider when everything else has not worked.
Hormone therapy, also known as ADT – androgen deprivation therapy. According to the U. of Pennsylvannia (Penn News), works by reducing levels of male hormones in the body, called androgens, to stop them from stimulating prostate cancer cells to grow. It is typically used in patients who have an advanced state of the disease, when the cancer has metastasized, or in those with a high risk of recurrence after their initial treatment. Unfortunately, this therapy may increase risk factors for Alzheimer’s and dementia, including loss of lean body mass, diabetes, cardiovascular disease, and depression. American men already have a 12% risk of Alzheimers occurring during their lifetime. So this is not a number that anyone would want to cause to further increase.
So this leaves us with the last choice – a radical prostatectomy. Many urologists don’t like to recommend that this be done right away, especially in the early states of prostate cancer. This is a major operation, though certainly not on the same level as a heart operation. Afterwards, you will have a catheter stuck in you for at least a week. Not fun. Then you will experience mild to severe incontinence and impotence for a while or possibly permanently. There is also no guarantee that some prostate cells haven’t already metastasized to other parts of your body … in which case you are back to a “wait and see” approach again, but this time minus your prostate and already dealing with the side-effects of the operation.
However, if the cancer is caught early enough, is still encased in the prostate capsule, has not migrated into the seminal vesicles or lymph nodes … this choice may be your best bet. Because, if it does work, you can be free of cancer. You can overcome impotence and incontinence with proper exercise (Kegel muscles) and if necessary some medication. You also do not have to live with a cancer in your body festering and slowly growing that might slowly reduce your choices of therapy to cure the problem if you do a “wait and see”. Remember, the older you get with the “wait and see” approach, the harder it will be to recover once you get to be 80.
Whatever your choice, what might seem best for you will not necessarily be the best path to take for someone else. However, it is important to consider all the choices and their side-effects and not necessarily sit back and do nothing, or maybe just go diving and forget about this for a while.