Friday, July 07, 2006

Basing cancer decisions on your "gut"

…Writing in the New York Times (July 4, 2006), Nicholas Bakalar says many men diagnosed with prostate cancer decide on a treatment option quickly and often base that decision on sketchy, anecdotal “evidence.”

…Treatment options include surgery to remove the gland, radiation from the outside, an internal seeding of the gland with radioactive material, or cryotherapy, which freezes the prostate.

…According to interviews with 20 patients, published in the August 1, 2006, issue of Cancer, 19 of the 20 had made the treatment decision based on a friend or relative’s experience.

…This can be very misleading, doctors say. Another person may have a different situation from yours.

…Although all 20 realized prostate cancer was slow-growing and they all had negative bone scans and CT scans, 12 of the 20 wanted to be treated immediately. Eight wanted their prostate removed surgically. They thought if the cancer was confined to the prostate and it was removed, problem over.

…However, even if the tumor seems confined, little metastases maybe sprinkled around and the cancer can recur even if the prostate is removed.

…Plus, you should not count radiation out. It sometimes has an even better 5-year outlook than surgery.

…Those who wanted surgery wanted it, period. The others looked at other options.

…Brachytherapy—insertion of radioactive seeds—was preferred to radiation from the outside of the body.

…These men thought it seemed more “direct,” aiming right at the prostate. Yet, the doctors know external radiation is just as targeted.

…If they thought they could dodge possible impotence from surgery by picking radiation, these men were also mistaken. External radiation and surgery carry a similar risk of impotence.

…The biggest thing to remember is, don’t rush in. For some men, a “wait and see” approach is perfectly acceptable medically, if your doctor mentions it.

...No, this does not mean you never need to be checked. Good try.


Bill Thomasson said...

Although there comes a time of life when it makes sense to skip testing. I mean, if you know you aren't going to choose active treatment, what's the point of being checked? And given that it typically takes 10 years for early prostate cancer to kill you and that treatment usually carries adverse effects of its own, you have to think about the chance that something else will kill you first. In fact, one study has found that among Medicare recipients (all, by definition, at least 65 years old and most probably older), there was no evidence treatment extended total lifespan.

So at some point -- maybe age 65, maybe 70, maybe 75, depending on general health -- it makes sense not to bother any more.

Star said...

Also--did you know that the Am College of Obstetricians and Gynos has said that if women have 5 clear paps, they can quit this fun deal at age 65?