Many men must face treatment decisions after being diagnosed with prostate cancer. These decisions are important and difficult in the best of circumstances. As in the case of all treatment decisions, there should be a risk/benefit analysis performed. Here are some important questions to ask the doctor: How likely is the proposed treatment to help me? What other treatment options are available? What are the risks associated with the various options? What will my sex life be like after the treatment?
The answer to the first question is complicated. No one wants cancer and very few people decide not to pursue treatment. However, there is controversy in the medical community about how much the various treatments for prostate cancer really increase the patient’s life expectancy. Prostate cancer generally takes two forms. The less aggressive form is slow growing and you are likely to die from something else before it kills you. On the other hand, the more aggressive form can be quite deadly, regardless of the treatment option chosen. At least be open to the idea that no treatment may be the best option for you.
Whatever treatment option you may choose, there are risks which come along with it. In the September 21, 2011 issue of The Journal of the American Medical Association is an article about predicting erectile function following treatment for prostate cancer. http://jama.ama-assn.org/content/306/11/1205.abstract Poor sexual function following treatment was the most common bad outcome from prostate cancer treatment and was very closely related to patient satisfaction with the outcome.
The answers found by the researchers are not reassuring. For all treatment options combined, only 53% of men who had functional erections prior to treatment still had them or had recovered them by two years after treatment. Your chance of having functional erections (one firm enough for intercourse) after treatment was found to vary based on the treatment you received. For example, 60% of men who had functional erections prior to prostatectomy (removal of the prostate) reported erectile dysfunction two years later. The figure was 42% in the external radiation group and 37% in the brachytherapy (internal radiation) group.
No matter which category a patient was in certain factors were found to be important predictors. The following were predictors of better outcomes: younger age, fewer other health problems, lower PSA scores, better sexual health and potency before treatment and plan for nerve sparing surgery.
It all comes back to what we have known for years. The better you take care of yourself, the better chance you have if illness strikes. If you aren’t taking care of yourself yet, start. It is never too late to start. If you are already taking care of yourself, keep it up.
When you talk to your doctor about your options, remember that doctors get paid for treating you. Don’t get sold a bill of goods. Don’t be too eager to accept a rosy prediction. Just because a doctor says it doesn’t make it true. Ask, evaluate, read online and get a second or perhaps even a third opinion. This is a big decision; one which you will have to live with for the rest of your life. If you do all this, no matter how things turn out, you will have the satisfaction of knowing that you made the best decision you could.
