This article is based on an article by Jill Margo in the Australian Financial Review on 24 May 2019 and my own experience.
When receiving a diagnosis of prostate cancer, some men elect to have no treatment. I know of one who did so, preferring to explore alternative therapies but without success. Anecdotally, after receiving the diagnosis some men never go back to their urologist. It took me nearly seven years to seek treatment after my first PSA test indicated a 50% likelihood that I had prostate cancer (which ultimately was confirmed and by then had spread to my pelvis).
For many men it is confronting to receive a diagnosis of prostate cancer. Some fear that incontinence and impotence will follow treatment – which it often does, at least for a period of time. Also, as with any surgery, removal of the prostate can have negative side effects.
Complicating matters, is the fact that it is currently difficult to predict which cancers will progress. Current estimates based on studies of large numbers of men indicate that 41% of prostate cancers are not destined to cause illness or death. Predictions for any one individual have a high degree of uncertainty and this is a major research topic.
A recent study interviewed eleven men who had biopsy-confirmed prostate cancer and all initially declined surgery or radiation. Most had felt pressured to have surgery and several had been told they would die without treatment – a prognosis that has not yet eventuated.
The psychological wellbeing of some was profoundly affected. Some had relationship breakdowns. Some sought alternative therapies. The careers of some were negatively impacted.
To doctors, the correct decision is not always clear and to reduce risk they sometimes recommend treatment even if there is a chance that it may be over-treatment.
Each man has to make his own decision, in consultation with the doctors and his family and friends.
Prostate cancer is a complex, confronting, and controversial disease. More research is needed to improve the quality of decision making.
My purpose in developing this website is to provide information and to raise money to contribute to the research and support needed to make better decisions.