SURVIVING
PROSTATE CANCER
WITHOUT SURGERY

INTRODUCTION:
THE ESSENTIAL TOOLS FOR FIGHTING PROSTATE CANCER
BY MICHAEL J. DATTOLI, M.D.

Having spent more than twenty five years studying prostate cancer and treating more than ten thousand men, I am well aware of the controversies in this field of medicine, including when to treat and when not to treat this disease. Many Americans don’t know that with the exception of skin cancers, prostate cancer is today’s most commonly diagnosed cancer, even surpassing breast cancer. The good news is that unlike other cancers, such as lung cancer or colon cancer, prostate cancer is typically more curable.

While we are learning more each day, there are still unsolved mysteries and many conflicting viewpoints about this disease. Some prostate cancers are rather indolent and slow-growing and may not require treatment, while others are rapidly spreading and potentially lethal, usually calling for some form of treatment. Some prostate cancer tumors make themselves known by driving up prostatic specific antigen (PSA) levels in the blood, while others lurk in the gland without raising the PSA red flag and can only be identified through skilled digital examination and highly sophisticated technologies such as color-flow Doppler ultrasound. Determining which prostate cancers are aggressive and life-threatening is crucial in deciding which patients should be treated.

What is a man to do in the face of the ongoing debates as to the value of PSA screening? My advice is to heed the recommendations of the American Cancer Society, the National Cancer Institute, and other mainstream organizations addressing prostate cancer issues: Consult your personal physician and consider having an annual prostate exam by a board-certified internist or urologist, beginning at age 50 (age 45 or earlier if there is a family history of prostate cancer or if the man is African-American). The exam should include both the PSA blood test and a digital rectal exam.

If your doctor suspects you may have prostate cancer, the only way to be sure is by undergoing a prostate biopsy and having a pathologist examine tissue samples. Make sure your doctor takes at least 12 core samples in the biopsy—the more samples, the better your chance will be of obtaining an accurate result. With regard to diagnosis and treatment, it is often wise to obtain second opinions from one or more specialists within the field, keeping in mind that each specialist is likely to be biased to some degree toward his or her own particular treatment specialty.

If you are diagnosed with prostate cancer, give yourself time to evaluate ALL your treatment options. Don’t make a panicked, knee-jerk decision while still in the shock of hearing your diagnosis. We are fortunate to live at a time when there are a number of effective treatment options for this disease. Some of these, such as brachytherapy and 4-Dimensional Image-Guided Intensity Modulated Radiation Therapy (4D IG-IMRT) — are relatively noninvasive and have profoundly improved our ability to maintain quality of life for patients. In addition, thanks to these therapeutic innovations, we are now able to successfully treat even high risk patients (those with high PSA values, high Gleason scores, and locally advanced cancer).

As you investigate your treatment options, depending on the specifics of your case, weigh the pros and cons of each type of therapy for which you are a candidate. And ask your doctor the hard questions about any treatment you may consider: How many men have you treated with this therapy? How many have a profile similar to mine? What are the published success rates of this therapy? What are your success rates? It is also wise to seek out other men who have been treated for prostate cancer. You may benefit by attending one of the Man-to-Man support group meetings sponsored by the American Cancer Society, or Us TOO International meetings.

By gathering all of the relevant facts that you can, you will be able to make a more fully informed treatment decision. I strongly encourage you to work with your doctor and become an integral part of that decision-making process. As you conduct your research, be cautious about what you read in the news media, and consider the sources. There are many misconceptions about prostate cancer that find their way into the media, including many of the popular medical websites and blogs on the Internet. Remember that just because something is “new” doesn’t mean it is better or has been proven to be effective. You will want to place your confidence — and your life and quality of life after treatment — in the hands of an experienced physician who can show you his or her long-term track record.

In my practice, which is entirely devoted to prostate cancer, I want my patients to be very comfortable with their treatment. The patient who has become informed and knows what to anticipate will come through his treatment with more practical knowledge and greater peace of mind.

Sometimes I can tell that a man is not going to be comfortable with any treatment other than one of the surgical options. Some men have that mindset. When I sense that is the case, I may tell him that if his test results predict that his cancer is still confined to the prostate gland, perhaps he can indeed undergo surgery if he is so inclined. In discussing treatment options with patients, I try to be as even-keeled as possible, knowing that the choice is ultimately theirs to make. At the same time, I want each patient to be aware as much as possible of the peer-reviewed results published in the field by the leading practitioners of each type of treatment.

I find that the data often speaks for itself. While it may sound very logical to say, “You have a cancer, and we should cut it out,” this option may not be so attractive if the patient is also told that even in the best surgical hands, there is a high probability that some cancer will be left behind after surgery, that there is a risk he may have to wear diapers for the rest of his life, and there is a strong likelihood that he will suffer from erectile dysfunction. Armed with this additional information based on the most recent surgical data, the patient may want to think very hard about his choice and at least consider other options. In the end, whatever he decides, each man should feel confident that he has made the right choice for himself based on his own particular needs and individual case.

The purpose of this book is to provide you with the most up to date and accurate information to help guide you from diagnosis to recovery. Before making any decisions about treatment, you should carefully evaluate the likelihood of cure for each treatment option and the risk of side effects that may alter your quality of life. Taking into account your age, overall health, and the extent and aggressiveness of the cancer, you will want to find a balance between treatment effectiveness and potential side effects — a balance with which you are comfortable and can live with before, during and after treatment. Regardless of the type of therapy you decide is right for you, having a positive mental outlook and knowing what to expect each step of the way are keys to winning the fight against this disease.


TABLE OF CONTENTS

Acknowledgments

Part One: The Non-Surgical Approach to Diagnosis and Treatment by Michael Dattoli, M.D.

Chapter 1: The Basics of Prostate Cancer
Chapter 2: The Diagnostic Tests for Prostate Cancer
Chapter 3: Considerations Prior to Treatment
Chapter 4: Treatment Options
Chapter 5: Radical Surgery
Chapter 6: Radiation Therapy
Chapter 7: Cryosurgery, Hyperthermia and HIFU Therapies
Chapter 8: Treating Metastatic Disease
Chapter 9: The Facts: Prostate Cancer Treatment Option Summaries

Part Two: Post-treatment Care and Lifestyle Changes
by Jennifer Cash, ARNP, MS, OCN®

Chapter 10: Coping with Side Effects
Chapter 11: Diet and Nutrition Guidelines

Appendices:
Appendix A: Where To Get Help
Appendix B: Glossary of Medical Terms
Appendix C: Questions To Ask Your Doctor
Appendix D: References
Appendix E: Charting Your Progress