Most men are asymptomatic when first diagnosed with prostate cancer and not only do they expect to survive but they expect to be cured without sacrificing their quality of life (QoL).
Since the four broad categories of definitive treatment options for localized prostate cancer (HIFU,CRYO,RADIATION and SURGERY) result in similar survival benefits, it is very important for the man and his spouse to have a clear understanding of treatment complications associated with these four categories of treatment as well as their impact on QoL issues. These treatment complications and resulting QoL issues can, not only impact the patient, but the wife and partnership as well.
Unfortunately,most urologists are unable to provide an unbiased discussion in counselling patients about the various treatment options since they lack the appropriate training in these treatment options. Fortunately,the Internet is available and the patient and family can mine it for information.
An issue of fundamental importance to the patient and his wife is the understanding that prostate cancer is easily cured WITHOUT the need for surgery whether it be robotics or conventional. Furthermore,suggestions that certain locally advanced prostate cancers should be debulked by surgery/robotics before additional adjunctive treatments are, not only merit less but harmful.
In terms of treatment complications and QoL impact,several issues are evident:
> men who underwent radical/robotic prostatectomy had a significant incidence of urinary complications.
> men who underwent radical/robotic prostatectomy had a significant incidence of sexual complications.
> men who underwent radical/robotic prostatectomy had the greatest incidence of secondary surgeries to correct complications.
> men who underwent radical/robotic prostatectomy had a high incidence of positive surgical margins with cancer left behind.
> men who underwent radical/robotic prostatectomy had a high incidence of penile shortening.
> men who underwent radical/robotic prostatectomy had a higher incidence of Peyronies disease than those that did not have surgery.
> men who underwent radiation/seeds had a significant incidence of long term bowel,bladder and sexual dysfunction.
> men who underwent radiation with the addition of long term androgen deprivation therapy (ADT) found that their QoL was further negatively impacted.
> treatment related complications and QoL issues were greater with older patients,those with high PSA’s and with the obese.
> Hispanics and Afro-American men were overall less satisfied in dealing with complications.
> spouses and partners are directly affected by the treatment complications as well and their QoL is impacted negatively.
Surprisingly,the treatment options for localized prostate cancer that have the greatest incidence of complications have never been required to prove themselves through FDA trials. Yet, the non surgical, non radiation, outpatient high intensity focused ultra sound (HIFU) therapy, also a definitive procedure for localized prostate cancer, is undergoing an FDA trial. Although HIFU is available world wide,it is presently only available in the US in certain select study sites under certain conditions. This scenario is the reason we travel to provide this state-of-the-art treatment.
A man and his spouse should know their treatment options for localized prostate cancer and also know the complications that result from these treatments as well as their effects on QoL.
” IN FACT,THE ONLY TIME I HAVE EVER HEARD A MAN SAY THAT SURGERY WAS THE WORST DECISION OF HIS LIFE WAS AFTER A RADICAL/ROBOTIC PROSTATECTOMY.”
Localized prostate cancer can be cured without sacrificing QoL. Get it right the first time and get it from an expert.