Prostate Cancer and the Newly Diagnosed: The Role of Patient and Doctor

By Simon J. Hall, M.D.

Simon J. Hall, M.D. is Director of the Barbara & Maurice Deane Prostate Health & Research Center at the Mount Sinai School of Medicine in New York City, and Chairman of the Department of Urology and Associate Professor in the Departments of Urology and Gene & Cell Medicine.

[An excerpt from the Foreword to Eat to Beat Prostate Cancer Cookbook]

When a man is initially diagnosed with prostate cancer, it is a disturbingly personal experience, associated with feelings of vulnerability, fear, and loneliness. For many men, this is the first time that their own mortality has come into view. In my experience, most patients are overwhelmed with these feelings of being alone, and they want to retreat and face their disease in private, even though friends and family may offer support. While dealing with these psychological issues, newly diagnosed patients at the same time must wrestle with the often difficult decision as to what is the best treatment: watchful waiting, radical prostatectomy, or the latest advances in radiation therapy and seed implantation.

At this juncture, what can a man newly diagnosed with prostate cancer do? First, it is important to understand that he is not alone. Following their diagnosis, many patients suddenly realize that they know a close friend or a distant relative who is a prostate cancer survivor. Discussions with fellow patients, whether one-on-one or through support groups, are important resources of solace, support, and information. The key issue is communication—and not to be afraid to talk about the disease and one’s own personal fears.

Secondly, access to information is critically important as a man works to make his own individual choices for treatment. The more information that is available and searched out and studied, the more likely a man is to be comfortable with his final treatment decision. Key to this process is a thorough self-education through books and the Internet. Equally important are consultations with a wide range of doctors, including at the very least, a urologic oncologist skilled in prostate surgery and a radiation oncologist specializing in either external beam radiation therapy or seed implantations. Many institutions now offer multidisciplinary programs whereby a patient and his family or support group can meet with a radiation oncologist, a urologist, and for more advanced cases, a medical oncologist, to fully discuss the patient’s options, the pros and cons of each treatment, and the effects on the quality of life—and all this very often in the same session. This multidisciplinary approach can help to make these difficult decisions a little easier, although at the time it is a lot of information to absorb.

Often access to information is difficult. Many men live in areas where it is not possible to find experienced prostate cancer doctors who will talk with them about what their diagnosis means and explain all the treatment options. For some of these men, it is possible to travel to a cancer center for information gathering. But for others, it’s not, which further underscores the need for the patient to continually educate himself, using all the tools that are available, wherever he lives.

I usually find it important to encourage the prostate cancer patient to be a more active participant in his own treatment. Many patients feel that they are at the "mercy" of physicians, and they are willing to defer to the experts. It is critically important to turn the tables so that the individual patient plays a more active role.