'Male Lumpectomy' May Help Some With Prostate Cancer

This idea of prostate "lumpectomy" cries out for greater publicity and serious attention among prostate cancer victims and the medical community.

I was diagnosed with low-grade prostate cancer in January, 2009: Gleason 6, localized, very small volume. I was led to believe that I had only three choices, one of which I should pursue as soon as possible: surgery, external radiation, or internal radiation (brachytherapy, or "seeds"). The common denominator: remove or destroy the ENTIRE prostate and accept the one-in-four probability of suffering urinary incontinence, erectile dysfunction, or both. It's the only sensible thng to do. (That's right, one-in-four: sources available upon request.)

After much research and consultation with mainstream, well-credentialed physicians I am now on Active Surveillance. What troubles me is that this was not presented to me as a rational choice immediately after I was diagnosed. I now undrstand that the reason for this is that, for a variety of complex socio-economic/political/scientific reasons, it is still a minority viewpoint among physicians who treat cancer. At the same time - and this is my main point - this minority is still very much in the MAINSTREAM of medical practice - Active Surveillance is being seriously practiced by well-credentialed MD's at such highly regarded institutions as Johns Hopkins, Memorial Sloane Kettering, and Thomas Jefferson University Hospital in Philadelphia.

Despite the above, I am resigned to the possibility that I will one day need treatment. Cryoablation has a strong appeal to me for precisely the reasons presented in this article - the plausible likelihood of cure with plausible reduction in the likelihood of life-altering side effects. But like Active Surveillance for younger men it appears to be championed only by a minority, because it's too early to evaluate the risk/cost versus benefit tradeoffs.

All of this raises the following question: What does it take for a new treatment to gain mainstream aceptance? In particular, how did lumpectomy for breast cancer become acceptable mainstream medical practice? I vaguely recall that there was initially much opposition to it in the medical community. I also recall that the courageous, eloquent persistance of many women - some of them facing the indignity of a double mastectomy - played a role in bringing it into the mainstream.

Perhaps it's time for for more men to take a similarly active role in attempting to influence the path of medical research and practice. This is as much a socio/political issue as a medical/scientific one. We "baby-boomer" males are now at the age where prostate cancer strikes - and there are a lot of us.

Mitchell D. Hirsch of PA 1:11PM August 22, 2009