Treating Prostate Cancer: The Choices.

01/08/2018 04:15 pm ET
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Hopefully you had the chance to read my first and second articles about how I handle the news of hearing I have prostate cancer. If you haven’t here is a link to them on my website. http://georgeasantino.com/book/blog/

This is the third article in a series of articles I am writing about how I deal with this challenge.

When I learned I had prostate cancer I was told I had to make a choice about how I wanted to treat it. The urologist told me I had three options: One was active surveillance, two was radiation, and the third was surgery. Of the three I liked that active surveillance option the best. What that entailed was repeating a blood test in six months to see if my PSA had changed. If it remained the same we would retest in another six months. If it increased we would do another biopsy to see if the cancer had gotten worse. I told the doctor I liked that one best but she burst that bubble quickly by saying that because she felt a tumor in the prostate she believed that the cancer was already too advanced to wait for a more aggressive treatment. This left me with only two choices; radiation or surgery. To help me make the decision my urologist got me an appointment with a radiation oncologist and another appointment with a surgeon.

The first appointment was with the radiation oncologist. I first met with her medical assistant. She asked me a lot of questions about my medical history and took my blood pressure. My blood pressure is usually low but this time it was higher. I can’t imagine why. She then began to tell me about the process. She said I would first have to go back to the urologist who would do a biopsy-like procedure where they would insert a tube into my rectum and move it near my prostate. Whereas the initial biopsy had stabbed me twelve times to remove tissue, this time I would only be stabbed three times and instead of tissue being removed they would place three rice-sized pieces of gold into my prostate. After these gold markers were placed I would go to another location to have an MRI of the prostate to map its location and size.

I would then return to the radiation cancer center where I would be placed on the table they would use for the radiation. A flexible material would be placed around my pelvic region and all the air would be sucked out of it to make a firm cast of my lower body. Using this cast ensured that every day I came in for treatment I would be placed in the exact same position.

The assistant then told me that they would use the gold markers, MRI image, and this cast to line everything up before they shot the x-rays into my body. She went on to say that I would be coming in five days a week for nine weeks for about a twenty-minute treatment. She then showed me a book.

The book was from the National Cancer Institute and was called Radiation Therapy and You. You can get a copy from their website https://www.cancer.gov . She began to leaf through the pages showing me the sections on different kinds of radiation treatment, the possible side effects, and what you could do to minimize them. She said that other than fatigue most of these side effects would be limited to the area being treated. So, for instance, skin irritation would be localized around my backside and the dreaded hair loss side effect would also only occur around the treated area. So, I’d have a less hairy butt which would make my wife happy. (She wanted to know if they could aim it a little higher and maybe reduce the hair on my back at the same time. They said they couldn’t.)

The assistant didn’t discuss the two side effects I cared most about which were incontinence and impotence. She said she would leave those to the doctor, who came in a short while thereafter. The doctor began by asking if I had any questions. I was inundated with a lot of information but the medical assistant had explained things very well. The only question I had was about the two big side effects I mentioned above.

The doctor pulled out a pen and drew a chart on a sheet of paper. She drew one line starting at 100% and took it down to about 40% over a five-year period. She then drew a second line starting at zero percent and then drew it up to 40% over the same period. She explained that with surgery the chances of my having incontinence and impotence after surgery were 100% but these issues resolve over time; going away completely sometimes in months, sometimes in years, but that after five years 40% of men will still be having some problems. She went on to say that with radiation these side effects do not occur but that over time, in this case five years, some men will start having problems with 40% being affected. This sounded like a pay me now or pay me later scenario.

I then asked if there were any side effects that would only happen with radiation. She said the main one was diarrhea which could occur during the treatment but resolve within two months after the treatment had ended. She also said that if you had BPH, which is an enlarged prostate that was constricting your urethra, there was a possibility that scar tissue could form, restricting it to the point that you would need a surgery called transurethral resection of the prostate (TURP) or what she jokingly called a roto rooter procedure to free the obstruction.

This all sounded very encouraging. Why have a major operation when radiation could fix things with minimal side effects. She then explained what some people consider the major downside to be and it’s that after treatment you don’t know if you’re cured. You see, the test for prostate cancer is your PSA count. If the radiation killed the cancer, as well as the prostate, there should be no PSA in your blood. However, because your prostate has been irradiated for nine weeks this test isn’t going to be accurate for eighteen months. That is, you won’t know for sure if you’ve been cured for a year and a half. The doctor did say that they’ve been treating prostate cancer like this for a long time and the clear majority of men show no cancer when the PSA test is finally done, and that chances are extremely good that I would be cancer free as well. The fact is you really don’t know for sure. Can you live without knowing? This was something to think about.

This meeting took over two hours and I was given a lot of information and I got to ask a lot of questions. I told the doctor that I had an appointment with a surgeon in a couple of weeks and she encouraged me to keep it and make sure all my questions were answered so I could make an informed decision about which treatment I would seek. Based on this visit I was really starting to lean towards radiation but just before I left the doctor handed me some papers that compared radiation treatment and surgery, including side effects. Much to my surprise the percentages of incontinence and impotence were much higher than she had said, with incontinence at 20% and impotence at 60% after two months and persisting for two years. Before I could ask the question, the doctor said that the studies were from 2003 to 2006. The numbers are much better now. I guess I still have more research to do.

My advice:

1. Read everything you can on the subject starting with Dr. Patrick C. Walsh’s Guide to Surviving Prostate Cancer.

2. Check out prostate cancer websites like cancer.gov, The Prostate Cancer Foundation, and The Seattle Cancer Care Alliance.

3. Take notes at these consultations and take someone with you. You’re going to hear a lot of information. When you run it all through your mind later your recall might not be entirely accurate. It will be helpful to have notes you can refer to and a person you can confirm thing with.

4. After your appointment review your notes. Chances are more questions will come to mind after the stress of the appointment has past. Feel free to call the doctor’s office back and ask these questions.

5. Try to stay as calm as you can. Take a break from all this by seeing a movie or going out to dinner with a loved one. I’m not a person who lets stress get to him but this is stressful. Don’t go it alone.

George A. Santino helps people who want to break down barriers, including self-imposed barriers, to success. Check out his Amazon bestselling book, Get Back Up: From the Streets to Microsoft Suites.

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