Many patients operate under the mistaken belief that doctors are generally similar. However, I claim that medical oncologists like myself are quite different. This is because oncologists have no innate preference for surgery over radiation. They perform neither. In my practice in Marina del Rey, I work with two additional medical oncologists—Dr. Richard Lam and Dr. Jeffrey Turner. The three of us compiled a table comparing all the different treatment approaches for Teal based on our perspective as medical oncologists.
Favorable aspects of a treatment are signaled by plus (+) signs, with a single plus being the least favorable and multiple plus signs being the most favorable. Negative problems are likewise reported with minus (-) signs with multiple minus signs being even less favorable.
Additional Issues to Consider:
Previous operations or radiation in the pelvic area increases the risk of side effects from radiation and surgery.
Prostate glands over 100cc can present a problem for men considering radiation.
Treatment intensity should be knocked down to what would be appropriate for a lower Stage of Blue—for example, Teal to Sky or Azure to Teal—in very elderly or frail men with multiple preexisting health problems.
Permanent loss of sexual and urinary function has huge consequences, affecting a man’s capacity for intimacy and his self-esteem. Doctors in the industry often gloss over potential side effects, implying that the risks are just about the same with every type of treatment. Studies do not support this conclusion. In a survey of patients at the University of Virginia, 785 men were questioned about their sexual and urinary function every 6 months for up to 3 years after surgery or seed implantation. Half of the men who received seed implants reported recovery of sexual function back to the same level as prior to treatment. Only one-fifth of the men who had surgery reported a similar degree of full sexual recovery. Regarding urinary control, about four-fifths of the men were “back to normal” after seeds, whereas only one-half of the men reported they were normal after surgery. Clearly, the claim that side effects are equal is wrong.
Men must put in the time to research their options. When it comes time to make the final choice, create a list of all the options still under consideration. Draw a line through the “worst” option and continue to eliminate options until only one remains. The final remaining option, unattractive as it is, is probably the best way to proceed.
ABOUT THE AUTHOR
Mark Scholz, MD is the Executive Director of the Prostate Cancer Research Institute. He is also the Medical Director of Prostate Oncology Specialists Inc. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center. He is co-author of Invasion of the Prostate Snatchers. He has authored over 20 scientific publications related to the treatment of prostate cancer.