Monday, April 9, 2018

Prostate Diary: The Docs Weigh In

One of out every seven men will get prostate cancer, and it's thought that all of us would if we didn't die of something else first. Prostate cancer kills about 25-30,000 men every year -- the most cancer deaths among men who don't smoke. For whatever reason, is a scourge among African-American men.

For what it's worth, I was not at risk: No family history of the disease, I'm in good physical condition, and I eat and drink in moderation. Sometimes, you just get it.

The diagnosing urologist presented me with two treatment options -- surgery and radiation -- and recommended that I read up on the subject and consult a radiation oncologist before deciding on treatment. He thought that at my relatively young age I would want surgery, and then added "but then I'm a surgeon." He recommended two books in particular, both of which proved problematic.

In the event, I read from the books, talked with survivors, and consulted with three urologists, a radiation oncologist, and a medical oncologist. The urologists included a robotics surgeon, a standard cut surgeon, and a brachytherapy (seed implants) surgeon. The collective advice was emblematic of the frustration and difficulty of dealing with this disease:

Urologist #1: Don't do radiation. Get it out and get on with your life. (The problem is that this is easier said than done.)

Urologist #2: You should probably get surgery, but radiation is a defensible option.

Urologist #3: You can do whatever you want. You're going to do well no matter what.

Oncologist #1: Your chances of a cure are the same (roughly 75% for localized Gleason 7 prostate cancer), so it comes down to a choice of side effects. But you have to do something.

Oncologist #2: Don't get surgery: You'll regret it. The outcomes are the same, so why court impotence and incontinence?

I wound up believing that there are good reasons to go either route, depending on who you are. I chose external beam radiation -- I'll get into why -- but I wouldn't presume to tell any man that that's what he should do. This time, it really is all about you.

No comments: