Facing Prostate Cancer
Seeking answers
By Robert Levy
Dana-Farber scientists take on prostate cancer
Perhaps more than for any other type of cancer, a diagnosis of prostate cancer is less an answer than a question. Because doctors have no reliable way of knowing whether cancer of the prostate gland is likely to spread and potentially endanger a man's life, detecting it ushers patients into a realm of imperfect choices and vague probabilities. If a patient is elderly and his cancer appears to be slow-growing, is he willing to "watch and wait," forgoing treatment for the time being but having his cancer monitored frequently for signs of progression? If his tumor falls into a gray zone of moderate growth, does he opt for aggressive therapy, even though such interventions can leave him with lifelong side effects, and his cancer may never have progressed if left untreated?
Such are the kinds of issues that arise when prostate cancer enters a man's life. And they arise often. In 2006, nearly 235,000 men in the United States will be diagnosed with the disease, and more than 7,000 will die of it, according to the American Cancer Society. It is by far the most common men's cancer in this country, although lung cancer and colorectal cancer claim more lives. The disease arises in the prostate, the walnut-sized gland that encircles the urine duct in men and provides the fluid that contains sperm (see illustration below).
Located below the bladder in men, the prostate is a walnut-sized gland that is involved in
semen production. Prostate cancer, in which abnormally growing cells form in the gland,
occurs mainly in men over the age of 50 and can be treated in several ways - or simply
monitored. Prostate cancer usually doesn't produce symptoms early on, and it is most
often detected because of an abnormal blood level of prostate-specific antigen (PSA).
For more information, visit www.dana-farber.org/prostate.
Illustration by Irina Zlobina
These numbers guarantee that prostate cancer will be responsible for tens of thousands of hospital stays, surgical procedures, radiation treatments, and hormone and chemotherapy prescriptions each year, even though doctors almost universally agree the disease is overtreated in this country. As many as half of all cases, experts say, could go safely untreated, never posing a threat to a man's health. The question is, which ones? Since current tests often provide no clear answers, many patients choose to err on the side of caution, agreeing to aggressive therapies that can eliminate or contain the cancer but that also carry a risk of life-changing complications,such as incontinence and impotence.
And when a patient does elect to have treatment, the question of which type can be just as unclear. The decision to have surgery, radiation, implantation of radioactive "seeds," or other forms of therapy sometimes has as much to do with patients' individual inclinations and preferences as with hard scientific data.
The situation can be perplexing for patients and families, frustrating for physicians, and nervewracking for everyone involved. But given the current state of knowledge about prostate cancer and its course of growth, some uncertainty is almost inevitable.
- Next: From patterns to predictions
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