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'You've Got Prostate Cancer'

An American man has a 1 in 5 lifetime chance of hearing those 4 words. What he will do about them is a decision that will affect the rest of his life.

So What Do I Do? continued...

One way to start thinking about the problem is to visit the web site of the American Cancer Society, www.cancer.org. The site has a helpful step-by-step tool to help consider the various treatment options as well as the various possible side effects. It also offers links to support groups.

Another resource is a version of a tool called a nomogram developed by Kattan's team at Memorial Sloan-Kettering Cancer Center. This computer program allows your doctor to enter a great deal of information -- not only about your tumor, but also about the things you want and don't want in a treatment. Once this detailed information is entered, the program offers an estimate -- based on real patient data -- of how likely it is that a certain treatment will have certain side effects. The program is free to physicians and can be found at www.nomograms.org.

"I think that with the nomogram, a patient is getting is our best prediction of his outcome with various treatment options," Kattan says. "He's got a better handle on how a treatment is going to work in his particular case, and it makes it easier to weigh the pros and cons of a treatment if you have better estimates of the likelihood of the outcomes."

"We advise patients to get a second opinion from someone in a different discipline," Scardino says. "If you have talked to a urologist, talk to a radiologist or an oncologist. Patients do feel caught in a dilemma about it. But just as there is not one right decision for you somewhere if you could only find it, no decision is always wrong. A surgeon, for example, may overestimate benefits of surgery and underestimate benefits of radiotherapy -- but both of those treatments can work."

What One Doctor Tells His Patients

The prostate biopsy has been taken, and today your doctor is going to tell you the results. He might tell you there's nothing to worry about. Or he might tell you that you have prostate cancer.

Here's how one doctor -- UCLA's Mark Litwin -- handles this life-changing interview, as told to WebMD.

"The first thing I do is, when I do a prostate biopsy I always schedule another appointment a week later. I always tell them to come with their spouse or with a family member. If the tumor is benign, well, they've only wasted a trip. If not, I give them the news that the biopsy was positive for prostate cancer. It ends up being a one-hour consultation. I tell the patient and his family what we do and don't know about his prostate cancer.

"The first thing we talk about is what we know: the tumor grade, his PSA level, how aggressive the tumor is, and whether it appears to be confined within the prostate capsule. If he has a high PSA -- greater than 10 -- or a Gleason score greater than 6, I send him to get a bone scan to see whether the cancer has spread.

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