Ken Koster's Part 2 for Prostate Cancer Survivor Newcomers

Date: Fri, 5 Feb 2010 06:11:25 -0500
From: Nancy Peress <nperess@CHARTER.NET>
Subject: Ron Koster’s Updated “WELCOME NEWCOMER!” -- Part 2 of 2

PCa is generally treated by three kinds of doctors: You probably saw a
UROLOGIST first. If the diagnosis indicates that the cancer has not
escaped the gland, it would be wise for you to see a RADIATION
ONCOLOGIST for a second opinion. If the cancer has escaped the gland,
a MEDICAL ONCOLOGIST might be the source of a second opinion. Some
patients seek a medical oncologist for another opinion even though the
cancer has not escaped the gland -- sort of a “neutral,” professional opinion.

You’re lucky to have found this source of information before you, your
friend or your relative has submitted to therapy. Even though you may
be “anxious” to “get on with it”, you can postpone treatment for a
brief period until you have done your home work, because you need to
know everything you can about each of the possible PCa treatment modalities.

The first group of treatments is used most commonly for men with
so-called localized prostate cancer that is confined to the prostate
itself or possibly to the prostate and the immediately nearby tissues:

- Active surveillance or watchful waiting (sometimes called expectant
management)

- Dietary, nutritional, and other forms of non-interventional
alternative therapy (potentially including acupuncture, nutritional
and/or herbal supplements, Essiac and green teas, positive mental
attitude, meditation, visualization, spiritual healing, humor, and prayer)

- Proton Beam Radiation therapy or PBRT

- Brachytherapy using either permanent radioactive implants (often
referred to as “seed implants”, or “SI”), or temporary radioactive
implants (often referred to as “high dose radiation”, or HDR”)

- Various other types of photon-based external beam radiation,
including Intensity Modulated Radiation Therapy (IMRT), Image-Guided
Radiation Therapy (IGRT), CyberKnife therapy, and others

- The different types of surgical treatment (radical prostatectomy),
which come in four basic categories: radical retropubic prostatectomy
(RRP), radical perineal prostatectomy (RPP), laparoscopic radical
prostatectomy (LRP), and robot-assisted laparoscopic prostatectomy (RALP)

- Cryosurgery (also known as cryoablation)

- High-intensity focused ultrasound (which has not yet been approved
for use in the USA but is available in other countries from
American-based physicians)

- Limited forms of hormone therapy using drugs like LHRH agonists,
antiandrogens, and 5 -reductase inhibitors either alone or in
combination with other types of therapy, often for limited periods of time


The second group of treatments is more customary for men with more
advanced forms of prostate cancer:

- Long-term or intermittent hormone therapies of various types,
including single-drug androgen deprivation therapy (ADT) and more
complex forms of ADT based on combinations of two or three hormonal drugs

- Chemotherapy, initially and usually using a docetaxel-based
(Taxotere-based) drug regimen

- Dietary, nutritional, and other forms of non-interventional
alternative therapy (see above)

- True watchful waiting in which therapy is avoided until symptoms
need to be treated

- Investigational drugs and drug combinations that are being tested in
clinical trials


We can help you learn more about this disease we call our hobby. The
diagnosis of PCa (like the diagnosis of many other cancers) is almost
always accompanied by the FUD factor -- FEAR, UNCERTAINTY, and DOUBT!
You can get rid of the FUD factor by taking charge; learn all you can
learn, so that YOU can decide which therapy YOU want.

A whole slew of good PCa books have been published. I have yet to
find the “perfect” book. I suggest you read at least these two for a
“more balanced” view:

- Guide to Surviving Prostate Cancer by Patrick C. Walsh, MD, and
Janet Farrar Worthington

- Prostate Cancer: A Non-Surgical Perspective by Dr. Kent Wallner.

The Patient’s Guide to Prostate Cancer by Dr. Mark B. Garnick is a
fast read, but there are now many, many other books available -- some
of which you’ll want to avoid -- some include misinformation; others
are scary enough to make you want to “take the pipe” rather than treatment.

After you’ve decided on the therapy of YOUR choice, you should seek
the most skilled, experienced practitioner available. Most survivors
agree that no matter what therapy YOU choose, you should do your
homework and be assured that the contemplated practitioner has done
several hundred successful procedures. There are individual
physicians who are highly specialized in all of the techniques listed
above, and other survivors will be happy to give you specific
recommendations, but ALWAYS remember that what worked for other
individuals may not work for or even be appropriate for you.

A listing of PCa SUPPORT GROUPS is available at several PCa Internet
sites. Most of the groups can be very helpful. Like doctors, you’ll
be more comfortable with some groups than others. In addition, there
are now several on line chat rooms and related support systems that
use interactive Web-based technology where you can meet with
survivors, physicians, and others willing to share their expertise.

When you are aware of all the PCa treatment options, the chances for
cure, recurrence, survival; their side/after effects; and you’ve
confirmed that information with other doctors, and men in support
groups; you may be ready to proceed. If not, don’t be bashful, come
back, share more of your concerns and ask us more questions.
Don’t waste a good opportunity to listen and ask questions when you’re
talking with a medical professional. Use a good tape recorder to take
notes every time you meet with a doctor, so that both you and your
partner are not pre-occupied with note-taking. Participate in the
discussion, and be sure you understand everything being said. You’ll
be glad for the opportunity to review the consultation -- probably
several times -- before you determine your treatment strategy.

Ron Koster, from the foothills of the Catskills