Making a Choice About Treatment
Most prostate cancers found in the early stages grow slowly. This means that you usually do not have to rush to make a treatment choice. Often, you have many weeks to many months from the time you first learn you have prostate cancer until you have to make a choice.
Many men use this time to find out more about the different types of prostate cancer treatment. Be sure to find all of the information you need to answer your questions and be comfortable with your decision.
It may be helpful to use this extra time to attend a prostate cancer support group to talk with other men who have faced the same decision-making process. Think about calling the National Cancer Institute’s toll-free number to request contact information for prostate cancer organizations. See Ways to Learn More for ways to reach them.
Research shows that men feel better about their treatment choice when they take part in making their own treatment decision. Making this decision can be hard to do. The following are some ideas that may help.
Be prepared when you talk with your doctor.
- Ask Questions. Ask your doctor or nurse questions that you are
thinking about, even if you are not comfortable asking them. These
questions can be about topics that are new to you or side effects that
concern you. Write your questions down and bring them to your
doctor visit. (See Asking Questions for ideas of questions to ask.)
- Know your health history. Your doctor or nurse will want to know about your health history. This history includes your family history, whether you have already had prostate surgery, and whether you have any other illness, such as diabetes or heart problems.
- Talk about your treatment choices. It’s important to ask your doctors about all the treatment choices that are open to you. This includes benefits (how each treatment can help) and long- and short-term side effects.
- Take part in making a choice. Men who take an active part in their treatment tend to feel better about their treatment than men who let others decide for them. Let your doctor know how active you want to be in making this choice.
- Think about what is important to you. Keep in mind what’s important to you and what worries you. This is also a good time for you and your spouse or partner to have an open, honest discussion with each other about your treatment choices and their possible side effects.
- Ask a family member or trusted friend or caregiver to come to doctor visits with you. This person can help listen, ask questions, take notes, and talk with you about what your doctor or nurse said.
- Get a copy of your pathology report. Ask your doctor for a copy of this report and bring a copy with you when you see new doctors. Your pathology report includes the results of tests that describe details about your cancer. If you are seeing a new doctor, it’s important to bring all the information he or she requests to your visit.
- Get a 2nd or even 3rd opinion. Seeking other opinions means talking about prostate cancer treatment with other doctors. You may want to talk with other prostate cancer specialists, such as those listed in the Types of Doctors box.
Getting 2nd and 3rd opinions can be confusing because you may get different advice. Because of this, many men find it helpful to see a medical oncologist for a general view of prostate cancer treatment choices. Talking with other doctors can give you ideas to think about or help you feel better about the choice you are making. Most insurance companies pay for 2nd opinions. Some companies even require them. It is better to get a 2nd opinion than to worry that you made the wrong choice.
Many cancer centers allow men to meet with a urologist, radiation oncologist, medical oncologist, and pathologist in one visit. Check to see if your treatment center provides this type of care.
Types of Doctors
Here is a list of types of doctors who treat prostate cancer:
- Medical oncologist. A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormone therapy, and biological therapy. This doctor is often the main health care provider for people with cancer. He or she can also treat side effects and may coordinate treatment given by other specialists.
- Pathologist. A doctor who finds diseases by studying cells and tissue under a microscope. Although you won’t meet with this doctor, he or she writes up a pathology report, which contains the information about your cancer from your biopsy or prostate surgery.
- Radiation oncologist. A doctor who treats cancer with radiation.
- Urologic oncologist. A doctor who treats cancers of the urinary system.
- Urologist. A doctor who treats diseases of the urinary system and male sex organs.
Learning as Much as You Want to Know
Many men with prostate cancer find that it helps to learn a lot about their cancer and its treatment. Doing so can help you feel more in control and at ease with the treatment you choose.
You can learn more by reading books and articles, searching the internet, or calling organizations that focus on prostate cancer. But keep in mind that too much information can be overwhelming as you are adjusting to your diagnosis. Instead, learn as much as you want to know when you are ready. Later, you can always find out more. Let your doctor or nurse know what else you need to know to be comfortable reaching a decision.
Some men want to read books and articles about the current research on prostate cancer treatment choices. Others prefer to meet with men in support groups who have had prostate cancer to learn how they made their treatment choices. Some men may not want to talk or think about it, at first. But later, they are they ready for more information. All of these approaches are natural ways to cope with a diagnosis of prostate cancer.
Thinking About Your Feelings and Values
It’s normal to have many feelings at this time. You may have many strong feelings at once. You may feel overwhelmed or angry. Your spouse or partner will also feel a range of feelings, but not have the same ones at the same time as you do.
Finding out you have cancer can bring up fears of the cancer getting worse or of dying. You may also worry about changes to your body or being intimate with your spouse or partner. Many men describe a feeling of loss—loss of the life they had before cancer, loss of energy levels, or the physical loss of the prostate. These feelings are a normal part of the coping process.
Your spouse or partner may be worried about losing you, changes to your lives, and how to best give you the support you need. At first, your loved one may want to talk about it more than you do. If you find that you need time to adjust and sort out your feelings and values, let your spouse or partner and family know your needs. Chances are that they are also trying to cope with the news and may not know how best to help you. If you are holding your worries and feelings inside for too long and your silence is hurting you or your family, ask your doctor, counselor, or religious leader for suggestions about getting help.
Reaching a decision about how you want to treat your prostate cancer is very personal—it is a balance of what is important to you, what you value the most, what types of treatment choices are available to you, and what the benefits and risks are.
Talking With Others
Along with talking with their doctors and spouse or partner, many men find it helpful to talk with others, such as:
- Family. This includes your relatives and close friends who care about you. They can support your treatment choice.
- Men who have faced prostate cancer. There is a lot to learn from other men who have faced these same prostate cancer treatment decisions. You may want to join a support group or meet with others to talk about the choices they made and what life is like now that treatment is over. Remember that while your stage of prostate cancer may be the same as someone else’s, your life and desires may be very different.
- Others who can help. You may have other people in your life who can help. This may be a neighbor, counselor, social worker, or religious leader you like and trust.
You may find it helpful to ask the following questions:
- What is the clinical stage and Gleason score of my cancer?
- Is my cancer low-, medium-, or high-risk?
- What treatment do you recommend?
Surgery (What type of surgery? Can the nerves be spared? How often do you do this procedure?)
Radiation (What type of radiation? What can be done to reduce side effects?)
- What are the short- and long-term side effects of this treatment?
- What are my chances of:
Becoming incontinent _______________________________
Developing ED? ___________________________________
Having other bladder or bowel problems? ________________
- What are the chances of the cancer coming back if I have this treatment?
- What are my chances of survival?
- May I have a copy of my pathology report? _____________
- If I want to have another pathologist look at my prostate biopsy results, how do I get the slides?
Making a Choice
“Prostate cancer gives you the opportunity to make a deliberate, considered choice. In the majority of cases, the disease is very slow growing and is never a medical emergency. With prostate cancer, you have ample time to assess the situation, evaluate your particular needs and resources, and devise the most sensible, strategic plan of action. Doctors can and should help you to understand your medical situation, but only you can decide what trade-offs you can tolerate, what level of risk you find acceptable, and which potential sacrifices you’re willing to make.”
—Dr. Peter Scardino, Chairman of the Department of Urology, Memorial Sloan Kettering Cancer Center