Article Abstract:
A 72-year-old retired man makes a decision to forestall treatment for his prostate cancer. He feels that the risks and side effects of surgery or radiation therapy outweigh the benefits in his case. Prostate surgery may cause impotence and incontinence. Radiation therapy can cause impotence. The patient strongly wants to retain his sexual functions and quality of life. The risk he takes is that the tumor could grow and spread beyond the prostate. However, it appears the tumor is progressing slowing as indicated by his serum PSA levels. The patient plans to return in six months to have his serum PSA levels checked. For a younger man, prostate surgery would be a stronger option, since prostate cancer progresses. But in an elderly man who may only live 10 years longer, aggressive treatment may not be desirable. The patient's physician agreed with his decision of watchful waiting.
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Article Abstract:
Primary care physicians should advise men with prostate cancer about the various treatment options and their side effects. A study published in 2000 showed that men will not get this advice from specialists. As of 2000, the only options that exist are surgery, radiation therapy, and watchful waiting. Watchful waiting means the man would be closely followed but would not be treated. Studies have shown that surgery and radiation are not necessarily more effective than watchful waiting. The truth is that most older men with cancer confined to the prostate will not die of prostate cancer even if they are not treated.
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Article Abstract:
Two 1998 studies shed further light on the prognosis of men with prostate cancer and the most effective treatments. One study found that men with low-grade, or mild, disease had a very low risk of dying even if they were not treated. Men with high-grade, or severe, disease had a high risk of dying if they were not treated. The other study showed that men with low-grade cancer will benefit equally from prostatectomy, radiotherapy, or radioactive implants. On the other hand, prostatectomy was significantly more effective than radioactive implants in men with high-grade cancer.
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