Choosing the best prostate cancer treatment is a complex matter. For that reason I’d like to review some treatment options in a two-part series, starting with the material below. I invite you to share your experiences and views in the comment section after the second part of this dialogue, which I’ll post tomorrow.
Prostate cancer surgery is just one of many prostate cancer treatments. But a large number of new patients select surgery, including up to 50,000 of 200,000 newly diagnosed prostate cancer patients every year in the USA alone.
Whether surgery is right for you as a newly diagnosed prostate cancer patient, depends on a number of factors. This is underscored in my response to a relatively young man, who asked me whether surgery was best for him. His question and my answer follow.
Q. Hello Rabbi, I’m an African American male, 47, and I been diagnosed with prostate cancer. My Gleason score is 6 and my last PSA (prostate-specific antigen) score was a 5 back in June. Would I be a good patient for surgery since I’m much younger than lots of men with prostate cancer? - G.H.
A. Many doctors advise African-American men to get PSA screening and, if necessary, a biopsy by age 40. So while you are 47 and “much younger than lots of men with prostate cancer” (your words), it’s important to realize several statistical facts:
• You are among Boomers (ages 45-64) who constitute 1/3 of all newly diagnosed prostate cancer patients each year.
• Your PSA score is just about double the PSA score of 2.5 ng/dl (nanograms of prostate protein per deciliter of blood), that’s regarded as the norm for men your age.
• The incidence of prostate cancer is 50% greater among African-Americans than among Caucasians. Put another way, while one of six American men will get prostate cancer in his lifetime, the figure is closer to one of four among African Americans.
* Although it’s been determined that you have a malignancy, before determining if surgery is best, your cancer must also be staged, that is, your doctor has to determine how extensive your cancer might be.
More than your “race,” it’s your age and overall health that is the most decisive factor in determining if surgery is right for you. Being relatively young and vigorous is one thing, but you need to find out if you might have a serious heart or other health condition, to see if surgery is counter-indicated. You can verify this only after a doctor takes your full medical history.
One thing is for sure, though: Most clinicians who treat younger men for prostate cancer would not advise their patients to go the route of active surveillance. This refers to a wait-and-see approach involving monitoring and repeated PSA screening over time, to determine if a more aggressive treatment is advisable.
The premise of active surveillance is that prostate cancer grows slowly in most instances, before the cancer can metastasize. So if you’re much older when first diagnosed, you might end up dying with, rather than because of prostate cancer. But at your age, with the prospects of living at least another 30 years, active surveillance is ordinarily NOT the best choice. In other words, the possibility of metastasis is much greater in the course of your next three decades, unless you decide now on a more invasive treatment like surgery/
Naturally because prostate cancer is so slow-growing, you could hold off on surgery or some other approach for another decade while submitting for now only to ongoing active surveillance. An acquaintance of mine did that to avoid treatment side effects and keep his lifestyle intact. Then, at age 60, he sought out a more active treatment.
In addition, if you’re lucky, you could hold off from surgery or other treatments for now, on the assumption that scientists might come up with better diagnostic and treatment tools by the year 2020. After all, with scientific progress 2020 may well be a year of improved sight and insight for us all!
(To be continued in Part 2)