Dr. Myers‰ Philosophy

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There are several issues that make prostate cancer difficult for patients and physicians. The most important problem is that prostate cancer is variable. In many men, this cancer grows slowly and does not spread beyond the prostate gland. In these men, this is a cancer that men die "with and not of." For these men, diagnosis and treatment may offer no advantage and may cause considerable distress. How slowly does cancer in these men grow? The cancer can be doubling every five to ten years. At the other extreme are men with cancer that doubles every 10 to 14 days. These cancers are growing as fast as the most aggressive cancers known, such as acute leukemia. These facts alone mean that no single approach is appropriate to all prostate cancer patients.

The second major problem is that prostate cancer occurs, for the most part, in men over the age of 50. These men may have a wide range of other medical problems that must be taken into consideration. Some of these men may be in their fifties and in vigorous health. Such men may well live to age 90 if prostate cancer can be surmounted. In contrast, other men may well be over 80 years of age with a wide range of medical problems that are more serious than prostate cancer. For example, newly diagnosed diabetes mellitus, a recent heart attack or emphysema may well be more life-threatening than many prostate cancers. Thus, it is important to consider prostate cancer in the context of a patient‰s overall medical situation.

One final problem arises from the fact that none of the treatments for prostate cancer are perfect and none have been proven effective. For early prostate cancer, we have a choice between surgery, radiation therapy, hormonal therapy or watchful waiting. Serious questions remain about the effectiveness of each of these approaches. Additionally, each of these approaches is accompanied with complications that can be serious. Dr. Myers believes there is no single right choice for all men. He believes that the appropriate approach is for the patient to view the physician as a carpenter who can build a ranch, colonial or split-level home and tell you how life is in each of these. Only you can decide which housing style matches your needs.

Unfortunately, many patients face this cancer while under the care of a specialist who uses only one approach. It is true that if your only tool is a hammer, everything begins to look like a nail! The patient hears the specialist passionately champion a single approach to this disease and takes the recommended course without considering the alternatives. Later the patient may discover that another approach might have fit his needs and personal goals much better. This process has created many angry patients.

Dr. Myers believes the only solution to these problems is for each patient to understand the nature of his cancer and the options for treatment in depth. The role of the physician should be to aid the patient in selecting the treatment that best fits the patient‰s needs. The Prostate Forum is specifically written to assist patients in decisions of this kind.

Treatment Options for Prostate Cancer

If you expect Dr. Myers to now tell you the choices are surgery, radiation therapy, or hormonal therapy, you are wrong. These are only tools, the real major decisions occur at a different level. There are several major approaches that can be used to manage prostate cancer and you need to understand these before even considering specific treatments.

These basic approaches are:

  go for cure,

  kill as many cancer cells as possible and then do what you can
            to slow the reemergence of this cancer,

  slow the disease as much as possible without compromising
            your  quality of life, or

  ignore the cancer for as long as possible.

If you decide that you want to try for a cure, then you can immerse yourself in the complex decision of whether to chose radical prostatectomy, external beam radiation therapy, radioactive seeds, cryosurgery or some combination of these treatments such as external beam radiation and radioactive seeds.

Dr. Myers believes that the available evidence indicates that many men diagnosed today have cancers that are not going to be cured by surgery or radiation therapy. All too often, men undergo these procedures only to experience a relapse after a period ranging from several months to several years. At this point, they again confront the issue of whether to simply slow disease progression or try an experimental approach that might offer cure.

Lately, he has become quite impressed by the tools we have to slow or arrest the growth of prostate cancer. We now have a range of relatively nontoxic drugs able to slow the growth of prostate cancer. Dr. Myers thinks this approach will come to play a large role in the management of prostate cancer. One focus of the Prostate Forum is to keep you informed about these advances as they develop.