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 I’ve blogged before about the importance of picking the right treatment option if you, or a loved one, have heard those awful words: “You have prostate cancer.” The decision is yours and yours alone. For your sake, don’t leave it up to the doctor, your wife, kids, parents or other prostate cancer patients like me.
Do your research about radical prostatectomy, internal and external radiation, “watchful waiting,” hormone therapy and other methods. Consider your probable life span, the side effects of each treatment.
If you do your homework, stay as calm as possible and make the right decision, chances are good you won’t end up like many of the men in a recent study. In the latest Cancer, researchers say more than a third of the men with early-stage prostate cancer frequently choose treatments that worsen any urinary, bowel or sexual problems they already have.
"Prostate cancer patients experience the same fears and hard decisions as all cancer patients do, but prostate cancer treatment directly affects very personal things that most people aren't comfortable talking about—urinary, bowel, and sexual function," says lead researcher Dr. James Talcott, of the Massachusetts General Hospital’s Cancer Center. “In this case, however, having that information matters because the three major treatments have different potential side effects.
“Knowing if patients already have problems in these areas should help guide treatment options."
Why all the side effects? The three most common types of treatments for prostate cancer—brachytherapy, or internal radiation; external beam radiation; and radical prostatectomy, a fancy name for surgery—are about equally effective in treating the tumor. However, each brings its own set of side effects, mostly affecting urinary, bowel and sexual functions.
So why all the side effects? The prostate is a walnut-sized gland that’s definitely not sitting out there all by its lonesome. The little bugger nestles in a bundle of nerves that control urinary and sexual function, so it doesn’t take a med school grad to realize that cutting around or zapping that area of the body with radiation will do a number on those nerves.
Given those side effects, Talcott says, a man with urinary irritation or difficulty passing urine, for example, may want to skip internal radiation, which will likely make the symptoms worse. Likewise, men with bowel problems probably should skip external radiation, which is notorious for inflaming the rectum as the power beams shoot through to the cancer in the prostate just on the other side of the rectal wall.
As for surgery, doctors perform nerve-sparing techniques to increase the chances a man will keep his sexual function. However, if he experienced problems getting an erection before he went under the knife, well, chances are darn good he’ll have an even worse problem after the surgery, Talcott warns. Diarrhea, bleeding, pain
In the Boston study, not surprisingly, more men who had bowel problems prior to external beam radiation therapy reported diarrhea, pain with bowel movements, bowel urgency, and rectal bleeding. Patients who had urinary problems prior to brachytherapy were more likely to report painful urination and more need to urinate at night.
Nearly all men with sexual dysfunction continued to have trouble after radical prostatectomy, regardless of whether a nerve-sparing procedure was used.
So why are men doing this to themselves? UCLA urologist Dr. Mark Litwin says men just don’t like to talk about pee and sex to doctors, thus making the physician’s job much harder in determining the extent of any problems prior to cancer treatment.
"It's not that men don't tell their doctors about their pre-existing problems, but that they have a skewed perspective of them, and as a result, of their treatment outcomes,” Litwin says. “We in medicine need to do a better job of sitting down with our patients and explaining how these treatments are going to affect quality of life."
What’s my take on this? Having pored over all the treatment options five years ago before choosing surgery, I can honestly say it’s damned if you do, damned if you don’t, as far as side effects are concerned. But like my mother—herself a cancer survivor—told me as they were wheeling me into the operating room, incontinence and impotency can’t kill you, but prostate cancer can.
Moms have a way with words, don’t they?
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