Treatment
Understanding a Prostate Cancer Diagnosis and Selecting a Treatment Require Work
For some patients, like me, the diagnosis of prostate cancer and the process of selecting a treatment plan are straight forward. From the start, my numbers indicated that I had a formidable beast to wrestle. My options and decisions couldn’t have had more clarity. Yet for others, the process is much more difficult.
My good friend, Terry, in Oregon is scheduled to have his radical prostatectomy this week, the day before Thanksgiving. While he will be passing on the traditional copious amounts of turkey and dressing, he will, just the same, have much to be thankful for this holiday. When he first received his diagnosis, his physician recommended a prostatectomy. When Terry first told me of his diagnosis, I provided a note of caution. Having just been through the process, his pathology scores and percentages seemed relatively low. If it were me, I explained, I would want more data before making a definitive treatment decision.
This freely proffered advice sent Terry back for another biopsy with many more sample cores removed (sorry, my friend…) and the solicitation of a second opinion. The second biopsy indicated that more of his prostate was involved and with higher diagnostic scores. The second opinion provided Terry and his wife an integrated consultation at Oregon Health Sciences University (OHSU) in Portland. Within a few hours, all on the same day, they met with a variety of prostate cancer specialists on the OHSU team. Armed with the data of the second biopsy and free of any one practitioner’s bias, they were able to arrive at a decision with which they are comfortable. I am sending prayers for a full and speedy recovery their way this week.
On the other hand, just last week, I came across a diagnostic ”close call” when I received a call from ABC News. One of their reporters, Calvin X. Lawrence, had been headed off for surgery when he solicited a third opinion from John Hopkins and ultimately found out that his cells were not cancerous. His doctor explained that Hopkins had found insufficient evidence to “establish a definitive diagnosis.” The Baltimore pathologists recommended a repeat biopsy to clarify their “highly atypical and suspicious” findings. Then, eight weeks to the day after his urologist had told him that he had cancer, he learned that he had “atypical” prostate cells but no malignancy. The similarities between the two are apparently enough to, in some cases, play tricks on pathologists.
While there’s no known cause, there’s no treatment. However, the condition is sometimes a precursor to cancer, sometimes not. That means Calvin will require aggressive monitoring for the foreseeable future, with quarterly PSA blood tests (instead of yearly) although as few biopsies as possible to avoid, as his urologist joked, “making Swiss cheese out of your prostate.” As Calvin writes, “I’ll take the deal.”
Read Calvin’s full story: When to Cut, When to Cut and Run.
Two men. Two very different cases. The moral of this story is not to scare men away from early detection and treatment, if needed. That would be lunacy. Rather, is it to underscore the importance of being an extremely active participant in one’s health care decisions. Until we have better, cancer-specific diagnostics and prognostic indicators, information, multiple consultations and an integrated approach to decision making remain the best medicine.
For some patients, like me, the diagnosis of prostate cancer and the process of selecting a treatment plan are straight forward. From the start, my numbers indicated that I had a formidable beast to wrestle. My options and decisions couldn’t have had more clarity. Yet for others, the process is much more difficult.
My good friend, Terry, in Oregon is scheduled to have his radical prostatectomy this week, the day before Thanksgiving. While he will be passing on the traditional copious amounts of turkey and dressing, he will, just the same, have much to be thankful for this holiday. When he first received his diagnosis, his physician recommended a prostatectomy. When Terry first told me of his diagnosis, I provided a note of caution. Having just been through the process, his pathology scores and percentages seemed relatively low. If it were me, I explained, I would want more data before making a definitive treatment decision.
This freely proffered advice sent Terry back for another biopsy with many more sample cores removed (sorry, my friend…) and the solicitation of a second opinion. The second biopsy indicated that more of his prostate was involved and with higher diagnostic scores. The second opinion provided Terry and his wife an integrated consultation at Oregon Health Sciences University (OHSU) in Portland. Within a few hours, all on the same day, they met with a variety of prostate cancer specialists on the OHSU team. Armed with the data of the second biopsy and free of any one practitioner’s bias, they were able to arrive at a decision with which they are comfortable. I am sending prayers for a full and speedy recovery their way this week.
On the other hand, just last week, I came across a diagnostic ”close call” when I received a call from ABC News. One of their reporters, Calvin X. Lawrence, had been headed off for surgery when he solicited a third opinion from John Hopkins and ultimately found out that his cells were not cancerous. His doctor explained that Hopkins had found insufficient evidence to “establish a definitive diagnosis.” The Baltimore pathologists recommended a repeat biopsy to clarify their “highly atypical and suspicious” findings. Then, eight weeks to the day after his urologist had told him that he had cancer, he learned that he had “atypical” prostate cells but no malignancy. The similarities between the two are apparently enough to, in some cases, play tricks on pathologists.
While there’s no known cause, there’s no treatment. However, the condition is sometimes a precursor to cancer, sometimes not. That means Calvin will require aggressive monitoring for the foreseeable future, with quarterly PSA blood tests (instead of yearly) although as few biopsies as possible to avoid, as his urologist joked, “making Swiss cheese out of your prostate.” As Calvin writes, “I’ll take the deal.”
Read Calvin’s full story: When to Cut, When to Cut and Run.
Two men. Two very different cases. The moral of this story is not to scare men away from early detection and treatment, if needed. That would be lunacy. Rather, is it to underscore the importance of being an extremely active participant in one’s health care decisions. Until we have better, cancer-specific diagnostics and prognostic indicators, information, multiple consultations and an integrated approach to decision making remain the best medicine.