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Currently, one of the most difficult truths we must face is that surgery alone cannot cure cancer that has escaped the prostate. Who should undergo surgery, and who should forego it? In recent years, this decision has been far less agonizing, and much more objective, because of what have come to be known as the Partin tables. Developed by urologists Alan W. Partin, M.D., Ph.D. and Patrick C. Walsh, M.D. of Johns Hopkins, these tables have quietly revolutionized the way doctors and patients are making decisions about treatment for prostate cancer.
Until these tables, there was no way to predict what urologists might find when they opened up a patient during radical prostatectomy. Would the disease be contained within the prostate, or would it have spread - and thus, was the surgery unnecessary? We could guess, but we couldn't be sure if microscopic, undetectable bits of cancer had already escaped the prostate. The Partin tables correlate the three things that we could know about a man's disease - PSA level, Gleason score, and clinical stage - to produce an accurate means of estimating the exact extent of a man's prostate cancer before surgery.
Knowing that information has enabled both patient and physician to make more informed choices about their treatment options for cancer, even in cases where it has spread beyond the prostate.
If you have a biopsy and receive a diagnosis of prostate cancer, take a deep breath, pause and don't feel rushed. Take the time you need to make an informed treatment choice. You will need to make a decision with the input of your doctors and family. You need to make an informed choice, one that is tempered and thoughtful, and is the right choice for you because decisions for prostate treatment really can and should be customized for the individual.
If you're not at the right medical center or with a doctor that you feel comfortable with, get into the right hands. Get to an academic medical center. Don't feel the pressure to make a decision before the sun sets. Prostate cancer, even in the worst-case scenario, is a disease that affords you the time to make a thoughtful, informed decision about what to do in terms of your treatment going forward.
There's a lot of misinformation around prostate cancer, says Simon Hall, MD, a urologist at The Mount Sinai Medical Center and director of the Deane Prostate Health and Research Center.
Once you receive a diagnosis of prostate cancer, you should go to the library or purchase one of the many books available to read up on it. The best examples include Dr. Patrick Walsh's book and the book published by the American Cancer Society.
After reading these books, you and your partner should be armed with questions that pertain to your particular situation. Then, in consulting your urologist, radiation oncologist or medical oncologist, you will be able to understand the pros and cons of the various approaches to this cancer. There is no one right answer for everyone.
The priorities to consider, in order of importance, include prostate cancer control, risk of urinary incontinence and urinary bother and finally the impact on sexual function after treatment. I would also talk to friends, family and local American Cancer Society Chapter to see if there are any resources in terms of psychological help/coping, dietary and lifestyle modifications, etc.
This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.