Prostate Cancer Diagnosis and Treatment Options

Prostate Cancer Diagnosis and Treatment Options – Opinion
Knowledge of  prostate cancer diagnosis and treatment options available, as well as the risks associated with each one is the first step in the process that will lead to one of the most important decisions of your life. That is, deciding whether or not to blindly accept, without question,  the advice of medical professionals to have life changing medical procedures or to take time out to study and research the diagnosis and the suggested treatment options, together with the health implications of each one, both short and long term. The potential side effects of some of the treatments are too life altering to leave this decision to chance and remember, prostate cancer is slow growing so there is plenty of time to consider your options.

To start with have a meaningful discussion with your doctor. Ask questions about each medical treatment option available to you and in particular, the side effects you need to be aware of especially those that will affect your ongoing quality of life.

While your treatment options become less viable if your cancer has progressed to areas away from your prostate gland, it is then even more important to be aware of what to expect following any treatment.

Some doctors and specialists; urologists and oncologists alike, can be biased when suggesting treatment options, promoting unnecessary treatments, CT scans, X rays, biopsies, and worst of all, surgery, chemotherapy or radiation therapy without fully considering the negative physical and mental implications to the patient. This will include impotence or incontinence (urinary and/or bowel), inconvenience and financial impost, together with pain and suffering. Such “preferred” treatments may not be the best clinical option for that patient. A factor that some men will find hard to accept I know but there is plenty of anecdotal evidence confirming this does happen, and all too often.

It is essential therefore, to seek a second and even a third opinion as to the correct diagnosis and prognosis to find consensus as to the most appropriate treatment option. Although it is possible, even probable, that you will receive diverse opinion from each consultation you will at least end up with enough knowledge and information to allow for further research and discussion.

The end decision is yours and yours alone so keep asking questions until you are confident of the route you want to take. Do not be ‘frightened’ into a hasty decision you will regret later. Prostate cancer is slow growing so time is on your side. Fear of cancer is your worst enemy.

Here are some of the options open to you.

Surgery:
Surgical options available are as follows…
A prostatectomy is where your entire prostate gland is completely removed.
A lymph node dissection is where only the nodes surrounding the urethra are removed
Each of the above procedures requires a hospital stay and you would be anaesthetized. These procedures can be effective although cancers have been known to return weeks, months, or several years afterward (metastasis). As well, side effects can include urinary incontinence, impotence and infertility.

A major consideration is that any invasive procedure runs a high risk of permitting the escape of microscopic cancer cells into the blood stream and migrating to other parts of the body, causing metastasis. And more often than not it is the secondary cancer, the metastasis, which is the deadlier one.

Radiotherapy:
There are 2 common approaches to radiation therapy in treating prostate cancer, external beam radiotherapy and brachytherapy.
External beam radiotherapy is a procedure where a high energy radioactive source is used to project a beam at your prostate from a short distance outside your pelvic area. No anesthesia is required and it is done on an out-patient basis. It is typically done on 5 consecutive days over a period of about 5 to 7 weeks.

Brachytherapy:  is the usage of about 100 to 150 small radioactive pellets or seeds. They are placed directly into your prostate with a syringe a few at a time; it usually takes up to 40 injections to implant them all. This procedure is painful and requires a general anesthetic.

These two procedures use radioactivity to burn away cancerous cells. Side effects include impotence, inflammation of both bladder and rectum. Cancers have been known to return.

Chemotherapy:
Drugs known to be toxic to cancerous cells are introduced to your body. It is used to slow cancerous growths and relieve pain. It is not a cure but it can be used to help patients where ‘cures’ by other means are not possible. But it does damage normal cells and can have a devastating effect on ones immune system – right at the time it needs to be optimized – not reduced.

Please do note also that the No. 1 side effect of chemotherapy is – get this – developing other cancers!  Did you know that in the USA, approximately 50% of all income made by the oncologist is from recommending Chemotherapy treatment? A nice earner indeed.  So isn’t the oncologist more likely to have a personal bias for this treatment option, one not necessarily in your best interest?

High Intensity Focused Ultrasound (HIFU)
HIFU is a procedure that uses sound waves to destroy cancerous cells. A focused ultrasound beam is aimed only at the regions of the prostate that are diseased with cancer. The cells targeted are destroyed using heat. Surrounding tissue is not affected by the beam and remains undamaged.

The entire prostate can be exposed to the ultrasound beam in about three hours. The procedure is done quickly and is effective in eradicating prostate cancer in over 90% of patients treated. Side effects are minimal resulting in urinary incontinence in only 5% of patients. Only 8% suffered urethral blockage and about 40% suffered sexual impotence. Impotence drops to 20% in patients whose cancer does not affect the prostate nerve. These reasons alone make HIFU the choice you should make when thinking about prostate cancer treatment.

Watchful Waiting:
This is a process of not treating the disease but monitoring it to see whether or not the condition will worsen and if it does, how quickly.

Active Surveillance:
As mentioned, in the past, the term watchful waiting meant no treatment until the further development of metastatic disease, after which androgen ablation (hormonal) therapy was commenced.

Today, men who have very low to low risk prostate cancer, and who choose not to have immediate treatment, are closely monitored with follow up intervention – where necessary – and when a cure is still considered possible.

This is commonly referred to, in conventional medical parlance at least, as active surveillance with selective delayed remedial intervention. This means that men undergo periodic evaluations including PSA tests, digital rectal examinations, and prostate biopsies. If there is evidence that the cancer is progressing, treatment is recommended with the intention of eradicating the disease.

Away form the more conventional forms of treatment above is what I consider to be the more enlightened way. It is the more beneficial way too with much better outcomes in most cases.

I’m talking about another form of Active Surveillance which follows a more holistic philosophy, using natural, alternative remedies. This is the course I have followed, seemingly very successfully, for the past seven years.. I do have half yearly blood analysis to check on various aspects of my physiology, including kidney (I have one only) and liver functioning, which is then followed up with my Urologist.

PSA Blood Test:

My PSA result is  recorded every six months or so. But I tend to ignore the results. Not only are the known causes for an elevated PSA many and varied and often unrelated to prostate cancer, the pathology too, is unreliable, being subjective. Identical specimens sent to two different pathology laboratories will invariably produce different results.

Routine Tests:

I routinely decline all offers of conventional medical treatment. Neither do I accept specific prostate tests, such as annual digital rectal examination, nuclear bone scans and prostate biopsies. And I won’t, certainly not whilst I have no clinical symptoms indicating otherwise. Having no perceived symptoms currently does not necessarily mean I have managed to kill it off, but I am sure hoping so. Without taking the option of further conventional tests, a biopsy for example, I’m afraid only time will tell. But I’m happy with that.

Benign Prostate Hyperplasia BPH

Now in my eighth year since diagnosis with an aggressive (Gleason grade 9. 5+4) prostate cancer, I have no obvious symptoms indicative of cancer. Of more concern to me is an enlarged prostate gland. This has given me serious problems from time to time over some 20 years, with numerous hospitalizations with blood clots blocking bladder action and necessitating surgery, three trans urethral resection of the prostate (TURP), during that period.

The last such procedure being in mid 2010 when a core biopsy taken evidenced no cancer cells present. A very encouraging outcome indeed, though I hasten to add this result is not conclusive. It was a biopsy on the prostate gland internal core only, so it cannot be said that there is no cancer present elsewhere, on the periphery of the gland for instance. To know that I would need to subject myself to another biopsy similar to the one at diagnosis and that I will not accept. Nevertheless, from my perspective, it does sound promising. And the result did confound two resident urologists attending. That in itself was pleasing.

Treatment Decisions Are Yours and Yours Alone:

Decisions to be made about cancer treatments are very individual ones. No two people are the same as indeed, no two cancers are the same. Even secondary cancers can be of a different type than the first one.

What matters is that the individual, using all available resources and information available to him, satisfies himself as the course of action he wants and then he must be prepared to stick with that decision come what may.

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