Being diagnosed with prostate cancer can be frightening. The more you learn, however, the less anxious you may feel. Your most important task after being diagnosed is to get as much information as you can about your condition. Then you and your doctor can talk over the best course of action. Because there is an array of treatment options, making the decision can be complicated. Here are the key questions to ask:
There are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen:
A frequent need to urinate, especially at night
Difficulty starting or stopping a stream of urine
A weak or interrupted urinary stream
Leaking of urine when laughing or coughing
Inability to urinate standing up
A painful or burning sensation during urination or ejaculation
Blood in urine or semen
Thanks to early detection, most prostate cancers today are found in the very early stages. "Twenty years ago, about one-third of newly detected cancers were advanced or had spread to other parts of the body. Today those advanced cancers represent less than 2% of prostate cancers detected," says Peter Carroll, MD, chair of urology at the University of California, San Francisco. The vast majority of men diagnosed with prostate cancer, in other words, have plenty of time to make a considered decision about treatment. "Probably the single most important thing I tell patients is not to rush to a decision,” Carroll says. “Get educated. Ask lots of questions. Take your time.”
How aggressive is my cancer likely to be?
Although doctors are very good at detecting prostate cancer early, they have a tougher time distinguishing between slow-growing and aggressive forms of the disease. Most men past the age of 70 have cancerous cells in their prostate that would never pose a life-threatening risk. Today, by combining information from PSA tests, digital rectal exams, imaging studies such as ultrasounds, and biopsy results, doctors can make an informed evaluation of the risk that an individual’s prostate cancer poses. In assessing risk, doctors also consider age, ethnicity, and family history.
Does my age matter?
Age is an important consideration. When it occurs in younger men, prostate cancer is often less aggressive than the same disease diagnosed in older men. Age is also a factor in deciding on the best treatment. A man in his early 40s who still hopes to have children may be more concerned about the possible side effects of impotence from surgery or radiation than a man in his 70s. Thus he might opt for watchful waiting – monitoring the cancer and treating it only if it progresses.
What are the risks and benefits of my treatment options?
Prostate cancer can be treated in a variety of ways, including surgery, radiation, and medication. Even within these categories, researchers have developed a variety of techniques, including three different ways to perform surgery, two approaches to radiation therapy, and several drugs that suppress prostate cancer. “With so many choices, doctors can tailor treatment better than ever before,” says Howard I. Scher, MD, chief of genitourinary oncology at Memorial Sloan-Kettering Medical Center. But the range of treatments also means doctors and patients must weigh many factors. That’s why it’s crucial to talk to your doctor about the risks and benefits of all your options.