Most doctors or physicians are still in basic agreement on the merit of the standard strategies for coping with stage 3 prostate cancer and stage 4 prostate cancer disease. In contrast, many experts not agree over the best approach for stage 1 prostate cancer and stage 2 prostate cancer disease and over the advisability of mass screening for early prostate cancers.
The conflict partly stems from the fact that the prostate cancer treatments are very risky. Published rates of complication may vary, but both radiation and surgery can lead to considerable impotence and to incontinence, bowel injury, and to death. There are study that older prostate cancer patients are more prone to complication than are younger prostate cancer patients.
Complication rates for surgery can go way down, however if the operation is done by a team that has great expertise in performing the nerve sparing technique from Johns Hopkins University School of Medicine. Surgeons who use this procedure avoid cutting into 2 bundles of nerves and blood vessels that are needed for penile erection and that touch the surface of the prostate gland. The procedure which is now applied in many medical centers also reduces bleeding and can facilitate reconnection of the urethra to the bladder after its severance during surgery.
Proponents of screening and prompt cancer treatment options of small tumors understand that there are serious risks involved in undergoing aggressive cancer treatment aimed at a cure. They, like opponents of such treatment options, are also disturbed by the lack of methods for definitively distinguishing patients who have indolent tumors from those whose tumors are likely to progress to a higher stage. But they believe that the patients who have the best chance of avoiding the horrors of metastatic disease should be given the opportunity to try to do so. Those patients are ones who are asymptomatic and who have small tumors that are confined to the prostate gland. To find these people, they reason, one must do screening tests.
Because of the cancer risks and costs, even advocates of aggressive therapy for early prostate cancer are divided over which age groups to include for screening and best cancer treatment. Some would rule out patients older than 70 years, on the theory that they are likely to die of other causes before their tumors progress enough to cause serious trouble. Others are more flexible and would actively seek and treat patients who are well into their 70’s, if the men were in good health.
Most advocates of invasive therapy for early prostate cancer stage disease and some who are skeptical of its benefits would favor treating patients who are in their 40 to 50 plus, including those with well differentiated, microscopic malignancies. First, some data suggest that prostate cancer is more virulent in younger men. Second, even if a slow growing tumor developed in these people chances are good that they would live long enough to see the tumor progress and metastasize.
One of the prostate cancer patients at the Dana Farber Cancer Institute at Harvard Medical School would agree with treatment enthusiasts. The patient was diagnosed with prostate cancer at the age of 70+ after his PSA score was slightly elevated in 2 successive test. A biopsy of the prostate show the indicator that a single cluster of cancerous cells was present. After many additional tests including biopsy of the patient’s lymph nodes, the patient was deemed to be free of metastatis. Wanting to be rid of the cancer, he underwent a radical prostatectomy from which he had a basically uneventful recovery. Although he was moderately active before surgery and his potency had not yet returned when last saw him, he remained delighted with his own decision.
Another one could argue that this patient should never have been treated. Opponents of early therapy are worried by an almost sixfold increase in the number of prostatectomies that were performed between 1984 to 1990, many in men older than 70 years. They point out that there is still no proof that aggressive therapy for early prostate cancer disease prevents the development of metastatic tumors and saves lives. That being the case, they fear that such cancer treatment which is aimed at avoiding a possibility that may never materialize is condemning too many men to years of impotence, incontinence and other disabilities.
They contend as well that even if a cure was achieved, the side effects of this treatment would often outweigh the benefits of any extra survival time gained. If treatment is undesirable, it follows that screening asymptomatic men for evidence of prostate cancer is unnecessary and wasteful.
Included in the concern of skeptics are men such as another patient of the Dana Farber Cancer Institute at Harvard Medical School. He was 51 year old, active businessman who underwent a nerve sparing radical prostatectomy after noninvasive and surgical tests showed he harbored microscopic cancer thru his prostate gland(stage 2A prostate cancer disease). After the operation he eagerly awaited the return of erectile function, knowing that about 70% of initially potent men in his age group who underwent the same procedure regained such function within a year.
But, one and half years later, his ability as a man had not returned. Greatly concerned, he tried so many treatment that dilate the blood vessels but they didn’t work well for him. In spite of counseling, he has had bouts of severe depression and has lost enthusiasm for maintaining his vigorous business interests.