From “The Decision” theprostatedecision.com
The decision of what treatment to choose is driven by several factors. It should be a decision that is tailored to you: “customized care,” as I like to call it. A common question to the urologist is, “What would you do if you were me?” A better question would be, “Who am I, what is important to me, and what is best for me?” The answers to these questions will vary from person to person and, in turn, will influence their decisions. These personal differences often explain why two seemingly similar patients will choose widely different courses of treatment.
What follows is a breakdown of the important issues that will influence your decision; your job is to examine each in the context of your particular situation. This self-evaluation will aid you in understanding the factors that will ultimately drive your decision. To do this, it is important to know the factors that distinguish you as a patient (your “who are you” factors), your underlying voiding pattern and potency level, and how each treatment will affect each. As a urologist, I commonly see the voiding side effects of the treatments, and for that reason, a particular emphasis on this aspect of the decision is discussed. Every patient with prostate cancer who receives therapy will have some voiding side effects. Because all of the treatments will affect how you void differently, an emphasis the on mechanics of male voiding and how it is impacted by the various treatments is discussed in detail. It is imperative that you understand the different issues regarding how you void. This is delineated in the risk-driven section.
“Who are you?” factors
Each of these categories should be evaluated in the context of your particular situation and then used together to make your decision. The relative importance each will play in your decision-making process will be determined by you and will be unique to you. With time, you will combine these “who are you” factors with all of the information about your cancer and your assessment of risk versus cure to arrive at the decision that is best for you.
General health, age, and years at risk-If you are young and healthy think aggressive treatments, if you are older with other medical issues think less aggressive and overly value ease of treatment and least potential for quality of life issues.
Your PSA, rectal exam, and biopsy report-You must know the specifics of your disease and the ramifications of each in your decision. Low PSA, low Gleason’s, normal rectal exam then you can go for the less aggressive therapies. If you PSA is high, your biopsy has high volume and high Gleason’s, then you have to be more aggressive in your treatment choices.
Bias- To thine own self be true. If you are biased toward or against surgery or radiation, this will heavily influence your decision. This is not right or wrong, just see it for what it is. Bias is not very scientific.
Cure is a priority-If cure is your primary factor then you will choose what you feel will give you the best chance of cure. You will value cure over potential for side effects or ease of treatment. Admiral Farragut-“Damn the torpedos. Full steam ahead.”
Risks are a priority-If you are this patient then you will make your choice by which potential complication worries you the most. Here you have to have a thorough and educated understanding of both the post-treatment issues of surgery and radiation. Hint-surgery is a pay me now risk, radiation is a pay me later risk.
Ease of treatment is a priority-This patient will choose by the “I want my cake and eat it too” method. The treatment that best blends risk with cure in their estimation. Again, this patient must see his choice for what it is-“I am choosing the treatment primarily because it will affect my life the least.”
What have you learned from family, friends, or the internet?-This is huge and a source of “bad information.” It’s Okay to do your research, but be careful. Run it through your caregiver. Remember the used car salesman analogy in” The Decision”, If you are betting on the used car salesman that does it every day or the guy buying a car once every five years,(who has found prices on the internet ) who do you think will win?
Misconceptions about prostate cancer-Yes most prostate cancers are slow growing. Yes most people die with prostate cancer instead of it. The fact remains that 30,000 men die a year in the U.S. of prostate cancer. If you are young and unfavorable parameters in your biopsy and PSA then making a decision based on the above misconceptions is a decision made in error. Everything has to be specific to you… don’t do what your friend or uncle Bob did because his prostate and his disease ain’t your disease.