Patients do have a choice in what treatment is given, especially when there is more than one effective treatment regime available for the type of cancer he has. Let’s assume I have a 65-year-old gentleman whose PSA was 6ng/ml and who was just diagnosed with a low stage, low grade prostate cancer (i.e. the cancer is still in the prostate and it is not the aggressive type). There are several treatment options for him. He can opt to do nothing for a period of time and wait to see how the cancer is behaving over time. During the waiting period, he may opt to take a pill a day or not. He may also decide that he does not want to “watch and wait”, but he wants to undergo curative treatment.

 

This may involve radiation or surgery. The radiation may be the external type (outside the body or shooting the cancer cells from outside) or the internal seed implant type. Even the surgery may vary from a cut, to keyhole surgery done by a surgeon alone or assisted by a robot. So, there are six to seven different options for the same cancer. What treatment he eventually ends up with depends on his and his family’s preference, his finances, his work, i.e. how soon he wants to return, his perceived risk of his cancer, the availability of treatment, the cost of treatment, the side effects of treatment and how fit he is to tolerate an anaesthetic.

These are some of the factors that affect his choice. This explains why, when discussing their health, and more so when discussing cancer treatment, men with prostate cancer should not attend the office alone. Presently, I have a rule that all men 50 and over will not be seen either in my private office or public clinic if they come alone. This rule has irritated and angered some men, but it’s the only way I can effectively help them, because virtually all men over 50, when they come alone, do something wrong.

 

They either miss the follow up appointment, take the wrong medication or dose, mix up the medication, finish the medication prematurely, lose the blood test form, do the wrong test, blame me of not informing them of what to do or a combination of the above, to name a few. You also have to spend more time with men explaining and still they forget the information. These men are not stupid and many of them are very intelligent and still they do the wrong thing almost every time. I am still to meet a man over 50 who did the correct thing all the time. Some of this is because the men themselves think that they do not need anyone and they can do it for themselves. This is all well and good until they become very ill, and the family then accuses the doctor of not informing them or of doing the wrong thing. This has been my experience and the experience of many of my colleagues.

So, you see, there is no one treatment for a prostate cancer. The other side of the coin is when a man presents with advanced prostate cancer. This is when the cancer has already spread. There are three to four different treatment regimes, ranging from hormone treatment to chemotherapy, to a combination. Most Vincentian men choose the cheapest option, not to realize that there is life after prostate cancer, even when it has spread. They fail to realize that they can live 5-10 years after a diagnosis of advanced prostate cancer and the outcome is based on their actions.

 

If they spend some money on their health, then they will enjoy the benefits of a longer, healthier end of days. My aim in treating prostate cancer is not only to help the man live longer (years to life), but healthier (life to years). In our ultra religious environment, where people feel thy are destined by God to live until they are 70, a lot of our older men do very little to live beyond 70, even though they would like to. There is a lot to be said about this in the next two to three weeks, when I discuss the treatment of early, then intermediate, then late stage prostate cancer.

 

For comments or question contact:

Dr Rohan Deshong

Tel: (784) 456-2785

email:  deshong@vincysurf.com