At the recent meeting of the American Urological Association in San Francisco, researchers presented studies regarding the decision-making process men go through when considering proposed prostate cancer treatments. Dr. Vorstman, renowned Florida urologist, believes these studies would have more meaning if patients were presented with information about prostate cancer treatment options in a different fashion.
Prostate cancer treatments fall into six broad categories: High Intensity Focused Ultrasound (HIFU), cryoablation (freezing), radiation therapies, surgical therapies, active surveillance and androgen deprivation treatment (ADT). Dr. Vorstman feels strongly that patients need to be presented with each of these options alongside all quality of life (QOL) issues and survival benefits. This allows patients to thoroughly research all of the risks and potential benefits of these treatment options.
Sadly, many urologists and Prostate Cancer Support Groups across the nation have little or no experience with all four of the definitive treatment therapies of HIFU, cryoablation, radiation or surgery, so many patients receive counseling and advice for just one or two treatments, usually those the doctor is the most familiar with. Therefore, many patients miss out on being presented with non-surgical minimally invasive treatment options. For this reason, Dr. Vorstman urges men and their wives to research all prostate cancer treatment options, using the Internet to find out about those options not offered by their physician.
Also, Dr. Vorstman suggests that patients have their prostate biopsy slides forwarded to a reference laboratory for validation. This is because there is considerable subjectivity involved in reading the slides leading to a lack of concordance between many pathologists and therefore a concern for the true status of your prostate and cancer.
Dr. Vorstman advises all men that localized prostate cancer may be treated with any of the four definitive therapy options of HIFU cryo, radiation or surgery as in the appropriately selected patient, these four treatment options for localized prostate cancer have similar survival benefits.
If the survival benefits for localized prostate cancer with these four treatment options are similar, what factors can the patient examine in order to separate these four definitive therapy options to make an informed choice for treatment of his localized prostate cancer?
Dr. Vorstman recommends that the patient and his spouse examine the various complications associated with each of the four definitive treatment options for localized prostate cancer and determine how these different complications can impact their quality of life (QOL). The incidence of complications is profoundly different between the four treatment options.
Because prostate cancer is one of the few diseases where the treatment complications affect not only the man but directly impact the spouse and their partnership, both man and wife should spend considerable time and effort in reviewing quality of life issues associated with the treatment option they have chosen or that has been proposed for them.
Surgical options (including robotic removal) have the highest incidence of complications and the biggest negative impact on quality of life issues for both the man and his partner. Since the survival benefits between the four treatment options for localized prostate cancer are similar whether the prostate is surgically removed or not, and the three non surgical options have less complications and a better quality of life after treatment, Dr. Vorstman encourages men to consider the non surgical options of HIFU, cryo or radiation. Of these three non surgical treatment options, HIFU is the most precise and appears to be uniquely positioned to afford cure with superior quality of life as well as being non radiation and usually accomplished in one outpatient treatment session.