After Prostate Cancer Diagnosis, Weigh the Options
Age is nevertheless important. The average age at diagnosis is about 73, according to a study published this year in the American Journal of Men's Health. Most doctors say robust younger men who are uncomfortable living with cancer should consider aggressive treatment, while older men or men with other health problems may be better off with active surveillance.
Characteristics of the tumor, including its size and apparent aggressiveness, are also key. "It's important for patients to realize that not all cases of prostate cancer are created equal, and that the debate over the role of watchful waiting versus treatment centers around patients with low- and intermediate-risk disease," stresses Yu-Ning Wong, a medical oncologist at Fox Chase Cancer Center in Philadelphia. "Patients with more aggressive [tumors] are at a higher risk of developing metastatic disease and really should strongly consider treatment."
But even in a case where some doctors would favor aggressive treatment to prevent possible metastasis, others might counsel watchful waiting to preserve quality of life. These differing schools of thought reflect a fundamental uncertainty among prostate cancer experts: whether aggressive treatment of early-stage prostate cancer actually extends patients' lives. It's an unnerving state of affairs for patients, and much of the decision comes down to how comfortable a man and his doctor are relying on clinical measurements and interpretative calculations, such as the so-called Gleason score that estimates the likelihood that a given tumor will spread and kill.
Given the uncertainty, how should a patient approach his decision? With patience, suggests Litwin, who urges men to take plenty of time before choosing a treatment. If you want the best care, he says, it's worth it to become familiar with the pros and cons of the various treatments, to get multiple medical opinions, and to be prepared to travel to a first-rate medical center in an urban area. But be wary of agonizing over the wrong details. "Men get so burnt out trying to pick one treatment over another they forget to put the same effort into choosing their provider," he says. "The quality of the provider trumps the type of treatment."