No matter the exact words that describe the results of your prostate biopsy, a diagnosis of prostate cancer forever changes everything. It can be confusing, frightening, and overwhelming. As someone newly diagnosed with prostate cancer, you might be torn by arguments favoring one treatment over another, or you may feel ill-equipped to make the decisions that are being required of you. But, if you want to be a partner in your own care, the more educated and proactive you are, the better.
SELECTING YOUR TREATMENT
There is no “one size fits all” approach for precise treatment of prostate cancer. As a matter of fact, your doctor may not recommend treatment at all (termed observation or watchful waiting) or might recommend putting you under active surveillance with serial testing and a plan to offer curative treatment for the cancer only if it exhibits signs of progression. It’s important to learn as much as possible about the treatment options available and, in conjunction with your physicians, make a decision about what’s best for you.
Because men diagnosed with localized prostate cancer today may live for many years or decades, it is important to discuss not only cure but also quality of life. Your decision-making process will likely include a combination of clinical and psychological factors, including:
• The need for treatment
• Your family genetics
• Your level of risk based on biopsy and exam
• Your personal circumstances
• Your desire for a certain therapy based on risks and benefits
Because men diagnosed with localized prostate cancer today may live for many years or decades, it is important to discuss not only cure but also quality of life.
Most men with newly-diagnosed prostate cancer should be seen in consultation with a radiation oncologist and a urologist. Men with more aggressive disease, or metastatic disease, should also have a consultation with a medical oncologist. A multidisciplinary prostate cancer care team will give you the most comprehensive assessment of the available treatments and expected outcomes, because each physician has expertise in different areas. Many hospitals and universities have multidisciplinary prostate cancer clinics that can provide a consultation on what team of doctors might be right for you.
In general, for nearly all cases of newly diagnosed localized prostate cancer, the chance of “cure” is now the same whether you have radiation therapy or surgery. In the U.S., the five-year survival rate for all men newly diagnosed with early-stage prostate cancer is greater than 99 percent. However, one treatment may be preferred for you based on the associated side effects, and your team of doctors will evaluate your type of prostate cancer to develop a treatment plan that may include radiation, surgery, some combination of both, or neither.
The main difference between surgery and radiation therapy relates to quality of life and side effects. Everyone has different priorities in regard to what aspects of quality of life are the most meaningful to them, so it’s important to take time to understand and process your diagnosis, as well as the therapy options available to you.
ASSEMBLING YOUR TEAM
Decisions about how to treat your prostate cancer can’t be made in a vacuum. A new diagnosis can come with a lot of confusing information and feelings. Many aspects of this disease can affect the way you view yourself, the way you interact with others, and the way others interact with you. Yet, at this chaotic time, you’ll be asked to make some important decisions, based on your doctors’ recommendations. To help you along the way, it’s prudent to work with your network of family, friends, and practitioners to align expectations and seek support as appropriate.
Know Your Fertility Options
After any of the most common prostate cancer treatments – surgery, radiation therapy, or hormone therapy – you are unlikely to be fertile. As part of the surgical removal of the prostate, the seminal vesicles and part of the vas deferens are removed, disrupting the connection to the testes. Orgasm may still occur, but ejaculation will be dry, and natural conception will not be possible. Radiation similarly destroys the prostate and seminal vesicles; chemotherapy and hormone therapy are both harmful to sperm production. If you are hoping to father a child in the future, discuss fertility preservation and sperm cryopreservation with your physician before you undergo any treatment.
Doctors and Practitioners Where possible, select a physician who specializes not just in cancer but in the nuances of your specific type of prostate cancer. How do you find such a doctor? If you are newly diagnosed, start by consulting your diagnosing doctor, that is, the one who found your prostate cancer. He or she may be an expert in the field, or they may refer you to one or more doctors who are.
Other factors to consider when selecting a doctor:
• Are they covered by your health insurance?
• Are they affiliated with a university or research hospital?
• Does their “bedside manner” align with your personality? Are they analytical? Compassionate? Do they seem interested in making you a partner in this process? Do they seem interested in what is important to you?
Remember: Take your time. Don’t be afraid to shop around and get second or even third opinions. Be careful of random advice; for example, “surgery is the best” or “radiation is the best” or “eat this herb and your cancer will be cured.” For accurate information, use data on reputable websites like pcf.org and those that your doctor recommends. Once you have committed, trust is key, but continue to be your own advocate: ask questions, do research, and remain curious.
Family Your family wants to support you. Feelings of powerlessness are a common concern around a cancer diagnosis; your loved ones want – or even need – to do something to feel like they are helping. Normally, this may feel like a fantastic offer. But after a cancer diagnosis, you may feel confused about how much support to accept, request, or reject. Keeping open channels of communication is the key.
• Tips for Spouses, Caregivers, and Adult Children Agree on how you will make decisions. Get ready for changes in routine. Understand that there could be emotions from both sides around changes in ability. Find out how treatments may affect moods, physical ability, and sexual function. It is normal to experience loneliness and fear around a cancer diagnosis. Don’t hesitate to seek out a support group for spouses or caretakers.
• Tips for Young Children Keep children informed, as age appropriate,
and treat them as part of the team. Be realistic but optimistic in your communications. For older children, you might encourage them to join a support group. For younger children, consult your therapist for suggestions on how much information to share.
Be careful of random advice; for example, “surgery is the best” or “radiation is the best” or “eat this herb and your cancer will be cured.”
Your Support Network Outside of your immediate family, there may be many close friends and colleagues who care deeply about you and have a strong desire to help. With friends and family who have volunteered their assistance, don’t be shy about letting them know a few specific things that would be helpful to you. Examples might include rides to treatment, meals, caring for young children, or performing difficult chores during recovery. And when things feel overwhelming, don’t be afraid to reach out for the support of family and friends. On the other hand, don’t be shy about saying no to help you don’t want, however generous. Many online resources exist for organizing volunteer resources during treatment, such as carecalendar.org and lotsahelpinghands.com.
You Sadness, fear, sleeplessness, and anger are all normal early emotions around a cancer diagnosis. Coping with these emotions isn’t something you should take lightly. Seeking professional help, either from an online community, clergy, a church group, a cancer support group, or a private mental health professional isn’t a sign of weakness. Taking care of your mental health is akin to the kind of psychological training that a quarterback goes through to make sure he can keep his head in the game: it’s vital. For more information on support resources, check out cancercare.org.
PROCESSING YOUR DIAGNOSIS
The final decision on treatment is yours and may be informed by a variety of psychological, as well as clinical, factors. Sometimes this decision process can be empowering, and sometimes it can be bewildering. For example, although the first instinct may be to choose a therapy from the first provider you see who promises to eradicate the disease, you should take your time to investigate your options. Depending on the features of your cancer, and your age, overall health, and personal family circumstances, active surveillance may be the right choice for you. Side effects of each treatment are also important to consider, and only you can know what potential outcomes are acceptable to you. Regardless of which treatment you choose, it’s important to observe recommended diet and lifestyle modifications from the moment you are diagnosed.
In the end, after all your research into different treatment types and side effects, different doctors, and different hospitals, the decision is going to come down to you. If there was one right answer that fit every man, we would tell you! However, the decision is very unique to you, and it may not be right for your brother, your friend, or any of the twenty other people you consulted, but you need to decide what is the best choice for you to get started on the road to better health.
Some people find the decision process liberating; others find it beyond their individual ability. Remember that it is okay to feel overwhelmed at first. Learn as much as you can about your options, but don’t be afraid to rely on professionals, friends, and family to help you navigate your final treatment plan.
Excerpted with permission from the Prostate Cancer Patient Guide, published by the Prostate Cancer Foundation. Download the full guide at www.pcf.org/2018patient.
This article was published in Coping® with Cancer magazine, March/April 2018.