Dealing with a Prostate Cancer Diagnosis

Women Are from Venus, Men Are in Their Own World?

Cancer is a family affair, whether we like it or not. The disease does not happen in a vacuum. When one is faced with a cancer diagnosis, family members (and friends) are also affected. Men and women respond to a new cancer diagnosis very differently.

In my practice as an oncology nurse navigator, I often meet with men newly diagnosed with prostate cancer, along with their wives. They have recently received the news from the urologist. The men have usually done extensive amounts of research, mostly on the Internet, and maybe picked up a few books as well. The women, too, can be very involved, usually helping with information-gathering, note-taking at the many physician visits, and reaching out to friends to find out if anyone else they know has ever dealt with prostate cancer.

Top 5 Patient Questions on PSA and Prostate Cancer

1. What is PSA?

   PSA means “prostate-specific antigen.” It is a protein that is produced by the prostate cells at a relatively low level in the prostate gland. It is not fully understood what causes prostate cancer, but we do know that in prostate cancer, the PSA is produced at a higher level than normal. One way to explain it is that prostate cancer cells are actually normal cells that have “lost their way” and have become abnormal, because of genetic or environment reasons, or because of random changes that make the cells become much more active than normal. When cancer cells are more active, they produce higher levels of PSA that can be detected with a blood test known as the PSA test.

2. So if my PSA is high, it means I have Prostate Cancer?

   Not necessarily. There are other reasons that the PSA is higher than normal. Although the risk for prostate cancer is greater when the PSA level is high, the PSA can also be high with no relation to cancer. PSA often rises with age, and this does not mean a man has prostate cancer. However, more than half of prostate cancer cases are in men aged 65 years or older. In addition, some men with prostate cancer don’t have high PSA levels. So it’s not that simple.

3. Do we know how fast my prostate cancer is growing?

   We don’t have an absolute measure for cancer growth. In prostate cancer, we use PSA levels and Gleason scores to attempt to gauge the aggressiveness of the cancer. PSA is measured and reported in numbers, but rather than a particular number, it is more important to know the trend of the PSA—is it going up or down? I’m more concerned with a PSA level increasing from 1.0 to 2.0 within 6 to 12 months than with a PSA that goes from 5.0 to 8.0 over several years.

   Gleason scores on the prostate biopsy samples describe how abnormal the cells look, on a scale of 1 to 10. A score of 6 is considered low risk for cancer, 7 is an intermediate risk, and 8 to10 is high risk for cancer.

4. Are there food or supplements that I should be using?

   Nutrition and exercise are good options for men with prostate cancer, which can help slow the progress of the cancer cells. There is no exact “dosing” in nutrition and exercise, but some healthy foods and exercise have shown to reduce cancer risk and can help prevent second cancers by providing an environment in the body that does not encourage cancer cell growth. Think of it as “starving cancer.”

5. A common question from family members: "Why doesn't he just have surgery to remove the cancer?"

   Ultimately, a man with prostate cancer must make the decision himself whether to have surgery or another treatment. But, it is important to consider family issues, as with any important life decision. Often, when looking at all the pros and cons of available treatments, with much attention to quality-of-life issues and possible outcomes, men still have effective treatment options other than surgery, yet another unique aspect that distinguishes prostate cancer from other cancers.

Treatment Options for Prostate Cancer

There is no one treatment that is appropriate for all patients with prostate cancer. The treatment depends on whether the cancer is localized or has spread to other organs, and the level of risk involved. You will have to discuss your options with your doctor or your navigator to understand what option is best for you. Also, a small cancer that is localized to the prostate does not always require treatment but only “active surveillance” by your provider. Treatment options include:

• Surveillance
• Surgery (Prostatectomy)
• Radiation Therapy
• Hormone Therapy
• Chemotherapy

In coping with a new cancer diagnosis, men are independent, a one-man army against prostate cancer. Women, however, are often interdependent in this situation, reaching out to friends, family, and perhaps support groups to help fight the battle...enlisting the troops. Sometimes, the man’s independence conflicts with the woman’s interdependence. A man can be so independent that he internalizes everything, strives to find all the answers himself, even hesitates to share the news. The women in these situations, whether they are wives, daughters, or friends, get frustrated. “I want to help him, but he won’t let me.” This is where problems can arise.

Recognizing how the other sex deals with a cancer crisis can help. Finding a comfortable middle ground should be the goal, as opposed to “my way or the highway.” Sharing detailed information about your cancer and the treatment plan with loved ones works better than just telling them not to worry. The more knowledge your loved ones have, the more understanding there is as you face the treatment and possible side effects. You will usually feel better when you share the load and gather support.

Uncertainty is all around you when dealing with a new cancer diagnosis. When you’re ready to share the news, go ahead and share the knowledge with loved ones, which will make everyone feel better. If you’re uncomfortable talking about it, write a blog or write a letter to express your feelings. Anything is better than bottling it up inside.

No one should ever have to experience the roller coaster of cancer, but if we are there, help and support from loved ones can make the ride feel so much smoother.