The prostate is a walnut-sized gland located just below the bladder in men.
Cancer in this small organ is the second leading cause of cancer deaths among American men.
But a diagnosis of prostate cancer in itself does not necessarily mean you are in for the battle of your life, doctors say.
There are varieties of prostate cancer that cause no harm. Others go for lengthy periods, a decade or two, before becoming aggressive.
A majority of men who reach 80 will have prostate cancer.
The decision about what to do with a diagnosis of prostate cancer depends on many variables including the age of the patient, the general health of the patient, the amount of prostate believed to have cancer cells, a pathologist's analysis of the propensity of your cancer to spread and the reading of a common but controversial test called the PSA.
The prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. High numbers tend to indicate cancer or they could indicate an infection.
"If you see a urologist walking around with a black eye, he probably got it in a fight with a colleague over the best course of prostate therapy," quipped Dr. Inderbir S. Gill, chairman of the department of urology at USC's Keck School of Medicine.
Gill and other specialists in the arena of prostate cancer treatment note that there is no study that indicates a best course of action.One would think prostate surgery would be ripe for the comparative effectiveness studies that marked the healthcare reform legislation debate.But prostate cancer specialists believe there are too many variables, and that the course of action must be tailored to the individual.Dr. Herbert Ruckle, chair of the department of urology at Loma Linda University Medical Center, said prostate cancer presents "a wide spectrum of disease and treatment options. There is not really one treatment that fits every patient. There is a spectrum of treatments for a spectrum of patients."While many can live a high-quality life for many years with some types of prostate cancer, there is another side, Ruckle said.Prostate cancer can and does kill. The American Cancer Society expects 3,035 deaths in California from it this year and 32,050 nationally.By comparison, the cancer society predicts 39,840 women nationally will die from breast cancer this year."Lung cancer kills fast," Ruckle said. "Prostate cancer is slow and painful. There is pain in the bones (where it frequently migrates) and difficulty with urination. There's weight loss ... It slowly robs people of their energy," he said.
"That's what makes it important for a patient to be informed ... to have effective treatment and good treatment," Ruckle said.For those diagnosed with prostate cancer, many specialists recommend patients get second and third opinions about what's going on.Dr. Henry Yampolsky, a radiation oncologist with The Center for Radiation Therapy of Beverly Hills, recommends patients see both a surgeon and a radiation oncologist to get both perspectives on treatment options. And of course, get both specialists' thoughts on waiting, he said.A decade ago, the idea of waiting to take action against any form of cancer was not a popular stance in the medical community. But recently, there's a greater recognition that for many prostate cancer situations, a period of watchful waiting -- with periodic PSA tests and biopsies -- can be the most appropriate measure.But many patients can't accept that, doctors say.One prostate cancer specialist, who did not want his name used, recalls a 90-year-old patient who couldn't sleep at night because he kept thinking about the cancer lurking in his body.It didn't matter that his cancer appeared to be a rather unaggressive variety. He wanted immediate action taken.All forms of treatment can lead to side effects, including incontinence and impotency, doctors say.
Dr. Timothy Wilson, chief of urology and urologic oncology at City of Hope, said that for younger men, treatment can make the most sense, as surveillance often is just a postponement of the inevitable.City of Hope has performed 5,000 prostate removals on its four Da Vinci machines.During time spent in the "watchful waiting" period, Ruckle and others recommend a "healthy prostate" diet -- one low in animal fats, limited in dairy products, high in the intake of vegetables, fruits and nuts."If that sounds familiar, that's because this is the same as a 'healthy heart diet' or a 'healthy brain diet,"' Ruckle said.Some 80 percent of the surgical removals of the prostate are done by the Da Vinci Surgical Robot, Gill said.Five years ago, only 2 percent were done with this machine, he said.The high magnification, excellent lighting, minimal bleeding offered with this machine gives surgeons an environment that allows the nerve tissues and muscles surrounding the operative area to be more easily recognized and spared.Therefore, it minimizes risks for impotency, for example.But the results of a study published in the Journal of the American Medical Association late last year questions whether minimally invasive techniques like Da Vinci reduce the risk profile of the surgery.
The study, which looked at nearly 2,000 minimally invasive surgeries and nearly 7,000 open (traditional) surgeries from 2003 to 2007, found a 30 percent increased risk of incontinence and a 40 percent increased risk of erectile dysfunction with the minimally invasive route.Gill said that those survey results incorporate the results of surgeries done while most doctors were just learning how to operate with Da Vinci machines."The machine doesn't do the surgery. A surgeon does," he said.He said outcomes have undoubtedly improved as surgeons became more skillful in their technique. Gill also questioned, on several counts, the validity of the information researchers used to develop this study's results.The complexity of interpreting this study underscores the difficulties and dangers of a layman basing how he will deal with his prostate cancer by what he finds on the Internet, doctors say.Clyde Marsh, 76, of Riverside, went through a period of watching, but then his PSA numbers began creeping up and doctors said it was time to have his prostate cancer dealt with.Marsh chose proton beam therapy at Loma Linda University Medical Center, a nine-week program that draws patients from around the country.Loma Linda officials say proton beams are more easily controlled than other external beam technologies and stay within the prostate without damaging nearby organs.
After talking to several doctors and several patients who elected differing prostate cancer treatments, Jerry Como of Pendleton, Ore., also opted for proton therapy at LLUMC.He ultimately chose proton therapy over robotic surgery in Portland."I heard good stories and bad stories," he said of robotic surgery.Como completes his nine-week course of treatment this week.During his time between treatments, Como has kept busy with water aerobics and other activities at Loma Linda University's Drayson Center and group activities -- such as golf -- organized by LLUMC employees with other prostate therapy patients.Como said that side effects from the radiation treatment have been virtually non-existent.
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