To Cure or to Manage Prostate Cancer; a Good Question

Steven E. North, Esq.

Prostate cancer is the second-most common cancer among men: More than 70 men die from it daily in the U.S., and hundreds of thousands more undergo testing and treatment for low-risk prostate cancer that is not likely to harm them. The changing nature of data revealed by research about the disease makes it increasingly perplexing to determine the best course for diagnosis and management.

It is essential that patients are fully informed of their options so that they, rather than – or in conjunction with – their physicians play the most important role in determining whether to move forward with biopsy and repeat biopsy, robotic surgery, radiation (external beam or brachytherapy), or watchful surveillance.

The fact is that in a low-risk-patient the side effects of treatment can be more harmful than the disease itself, namely severe bowel, bladder and erectile problems. Patients may also be subject to severe infection from surgery or a biopsy, incomplete robotic removal of the cancer, and even death.

A high majority of prostate cancers, however, grow so slowly, it is likely that the patient will die of some other cause. Some poorly advised patients opt for radical surgery or other aggressive means because they want the cancer out. They do not understand that careful monitoring generally allows for timely intervention should a lesion become more aggressive.

The critical determining factor in choosing a protocol is the nature of the cancer itself: Is it aggressive, slow growing, metastasized? A patient’s age or life expectancy should also drive the treatment or management decision. A senior citizen can outlive the cancer, whereas a younger man may need more aggressive management.

Fortunately, new tests can more clearly indicate the aggressiveness of a cancer. As more new tests emerge, it is expected that more men will learn that they have slow-growing cancers that require nothing more than periodic surveillance. The real test will be whether a patient is confident enough in this assessment to forego a treatment that can eradicate his cancer.

The prostate cancer cases that end up in medical malpractice litigation are often those where the PSA test result is overlooked by the physician or the acceleration rate of change in the results is not appreciated.