Dec 6, 2013 — Although prostate cancer isn’t likely to kill you, it can have a very negative impact on your quality of life. For men who have been diagnosed with the disease, figuring out the right treatment option can be overwhelming. Dr. Jonathan Tward from Huntsman Cancer Institute discusses the different treatment options for prostate cancer and how to figure out which option may be the best for you. He also talks about the potential side effects of choosing the wrong treatment option.

Interview

Interviewer: You've been diagnosed with prostate cancer. What next? We'll talk about that on The Scope.

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Interviewer: For men that have been diagnosed with prostate cancer, figuring out the right treatment option can be really overwhelming. Dr. Jonathan Tward specializes in prostate cancer at Huntsman Cancer Institute. Dr. Tward, what treatment option would you recommend for a man just diagnosed with prostate cancer?

Dr. Tward: It's really an equally important question in a cancer that often won't take someone's life, Should they be treated? Because the treatments themselves can just as easily impact someone's sexual health, urologic bother, or bowel bother. One of the problems with prostate cancer, which is sort of unique to prostate cancer and different from other cancers, is that unlike other cancers where there's a very defined treatment paradigm, this particular cancer has many treatment options, and it is overwhelming to a lot of men who are faced with a new diagnosis of a relatively early stage cancer. Should they choose a surgery? Should they choose one form of radiation therapy or another radiation therapy? It's a big struggle for a patient who is contemplating their mortality to also have to go through the various treatment options and side effects because, honestly, when you start parsing treatment options for prostate cancer, there are essentially 20 different little ways of skinning that cat. It can paralyze people with this anxiety over 'Am I choosing the right thing? Am I not choosing the right thing?' So one of the things that I advocate for to a patient who is diagnosed is if they have an early stage prostate cancer, which is 80 to 85 percent of new diagnoses, they should speak to a urologist because the urologist will specialize in the surgical management of that disease. However, they should also speak to a radiation oncologist who specializes in the curative treatment of that disease with radiation therapy because they have non-surgical treatment options that are just as curative as the surgical option. But you're starting to choose on subtleties of different side effects.
When you're talking about sexual function, especially, this can become very important. There are certain ways of doing the surgery that will guarantee that you have erectile dysfunction whereas there are other ways of doing the surgery that will improve the probability that you don't. Or you might decide that radiation therapy in the form of external beam treatment or seed implants may have a favorable sexual function preservation rate relative to surgery, maybe, at the expense of an increased risk of a bowel bother. So men struggling with these treatment decisions are trying to balance risks of side effects to their urinary functions, risks of side effects to their bowel, and risks of side effects to their sexual function. And that's what is very challenging in terms of making treatment decisions.

Interviewer: And it doesn't sound like there's any easy way to really pick one. It sounds like you just kind of got to go through the options and then decide what's important to you.

Dr. Tward: Right. There is no way, and the reason that I advocated speaking both to your urologist and radiation oncologist is that a urologist, and rightfully so, should be biased towards 'You should get surgery' and may kind of communicate that perspective to the patient whereas a radiation oncologist may be biased that you should get radiation. But ultimately, you want the patient to hear the experts in those fields kind of discussing the details with therapy. If they're fortunate and maybe have friends who have gone through the different kinds of treatments, they can ask one friend who's had one form of treatment and another friend who's had another if they have that luxury. Or they can join a men's group where they can easily talk to men who have had different perspective. They can even include their primary care doctor in that decision making to help them kind of go through this decision and make an informed decision.

Interviewer: So there are men's groups that actually help support this sort of thing?

Dr. Tward: There are men's groups. The men's groups are not as active as, let's say, breast cancer groups.

Interviewer: Sure.

Dr. Tward: Women are very motivated to have survivorship groups and support groups, and men historically have been a little less motivated, but they do exist.

Interviewer: And you think they're a good resource?

Dr. Tward: I think they're an excellent resource, especially because it's one thing to hear a doctor tell you what you think and what you might feel, but it's another thing to hear it from someone who's gone through it. As much as I think I know about prostate cancer and what it feels like to get radiation therapy or what it feels like to get surgery, it's never been done to me. So I think there's extreme value in talking to people who have endured our therapies and the possible side effects.

Interviewer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.