Prostate cancer is an insanely complex disease. So far, scientists have identified 27 subspecies or “genotypes of prostate cancer. That’s just one reason why there’s nothing straightforward about diagnosing and treating prostate cancer. It’s a complicated maze with numerous boulevards, streets, intersections, and the occasional blind alley when it comes to dealing with this disease.
Indolent or Aggressive?
PSA—prostate specific antigen—is the only semi-reliable way to tell what’s going on in a guy’s prostate gland. Cancer causes PSA to rise—but not always, as I can personally attest. Sex or even recently riding a bike also raises PSA. There’s not even agreement on what a “normal” PSA level is because “normal” for one guy may be elevated for another.
The only way to diagnose prostate cancer is via the threatening-sounding “needle biopsy.” And if the biopsy shows cancer, 80% of the time it’s so slow-growing–“indolent”– that you’re almost guaranteed to die of something else first. But just knowing there’s a cancer growing inside–no matter how slowly–is not a comfort-inducing state, and many men are eager to be rid of it no matter what. But too often the cure is worse than the disease. Sometimes it’s incontinence. Most often it’s at least erectile dysfunction (ED) if not outright impotence.
The other 20% of the time it’s aggressive cancer and it needs to be treated forthwith.
So Many Treatment Choices
Whether indolent or aggressive, when a man finds out he has prostate cancer he is confronted with a range of choices and usually not a lot of help about what to do next. Each sub-type prostate cancer will affect each man differently. He often winds up with a “customized” version of cancer that may respond to the same treatment quite differently than the guy standing next to him.
So how to decide to treat it? There are few other cancers that have so many ways of being treated. Surgery? Radiotherapy? Brachytherapy? Hormone therapy? High frequency ultrasound? Cryotherapy? (These latter two are not yet approved by the FDA). Combinations of these? Even not treating a slow-growing cancer can be an option.
So what’s the answer? It all depends.
And no matter what you may hear, every treatment has consequences. Side effects such as impotence that some doctors may not be eager to discuss.
And what about the whole other side of cancer that the medical community tends to ignore? Things like cancer’s emotional impact. Its effect on relationships. What cancer does to some people’s spiritual state.
If you’ve been diagnosed with prostate cancer, you’re setting out on a long journey. You’ll want some maps along the way. This site (and many others) can help.