By Michael J. Dattoli, M.D.
Having spent more than thirty 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. Prostate cancer is one of the most commonly diagnosed forms of cancer, with the American Cancer Society estimating that nearly 300.000 men will be diagnosed with prostate cancer in 2024. The good news is that unlike other cancers, such as lung or colon cancer, prostate cancer is typically more controllable and curable. At our center, we are providing the most advanced radiotherapy treatments for prostate cancer, namely Dynamic Adaptive Radiotherapy (DART) and brachytherapy (radioactive seed implantation).
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 at all, while others are aggressive, rapidly spreading and potentially lethal, thus requiring aggressive 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/or highly sophisticated imaging technologies that we provide such as 3D Color-Flow Power Doppler Ultrasound and Multiparametric MRI (magnetic resonance imaging). Determining which prostate cancers are aggressive and life-threatening is crucial in deciding which patients should be treated.
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. For more information on biopsies, please see the linked webpage on the advantages of Transperineal Prostate Biopsy contributed by my associate, Dr. Arvind Soni.
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 you are still in shock after hearing your diagnosis.
We are fortunate to live at a time when there are a number of effective treatment options for this disease. These include Dynamic Adaptive Radiotherapy (DART), which should utilize all the most sophisticated 4D modalities, and seed implantation, known as brachytherapy (pronounced brak-e-therapy). At our center, we have achieved exceptional long-term success rates by combining these two forms of radiotherapy and by utilizing DART and brachytherapy as a salvage therapy for recurrent prostate cancer. With brachytherapy implants, we strongly favor permanent radioisotopes over temporary implants.
These sophisticated types of radiation therapy are relatively noninvasive and have profoundly improved our ability to maintain quality of life for our 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 type of therapy? How many have been cases similar to mine? What are the published success rates of this form of treatment? What are your success rates?” You may benefit attending one of the Us TOO International prostate cancer information and support meetings, our own Prostate Café, or other such groups in your area. By gathering all 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, proactive 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 that 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 treating prostate cancer.
In my practice, which for many years has been in large part devoted to diagnosing and treating cancer, especially 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.
In the past, radical surgery was considered the “Gold Standard” treatment for prostate cancer; but in recent years the evidence-based data shows virtually no advantage and many disadvantages with surgery – whether robotic and by hand – compared to other forms of treatment, especially the most sophisticated forms of radiotherapy.
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 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, including both radiation and surgery.
I find that the evidence-based 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 as attractive if the patient is also informed 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 website is to provide patients considering advanced treatments such as DART and brachytherapy 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.
