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Why Men Sometimes Choose Not To Get Prostate Cancer Treatment

by — 2015-12-04 in Men's Health
Many men who are diagnosed with prostate cancer opt not to get treatment. Here are some of the reasons why.

Prostate cancer is, after skin cancer, the second most common cancer in men in the United States. The American Cancer Society estimates that 200,800 men will be diagnosed with prostate cancer in the USA in 2015. One out of six white, Hispanic,and Asian men in the United States and one out five African-American men will be diagnosed with the disease at some time during their lives.

Prostate cancer rates differ by as much 5000 percent from country to country. The disease is most common in northern Europe, Australia, and the United States, and relatively rare in South Asia and North Africa.

How Is Prostate Cancer Treated?

Prostate cancer is most commonly treated with surgery, the removal of the prostate, or radiation, the planting of radioactive "seeds" around the prostate to deliver a continuous dose of radiation. The disease may also be treated with hormone therapy, usually hormones to counteract the production of testosterone, and sometimes by cryosurgery (freezing), high-intensity ultrasound, or focused proton-beam radiation. 
 
Surgical treatments include nerve-sparing techniques, designed to minimize the frequency of impotence or incontinence after the procedure, laparoscopic procedures, which involve smaller incisions, robotically-assisted procedures, which are more precise, and the classic retropubic prostatectomy and perineal prostatectomy, both of which involve large incisions and cutting through considerable tissue.

Complications Of Prostate Cancer Treatment

A study published in the Jan. 31, 2013 issue of the New England Journal of Medicine confirms that there are long-term complications to prostate cancer treatment. Researchers enrolled 1,655 men in the Prostate Cancer Outcomes Study (PCOS). In this group, 1,164 had had surgical removal of the prostate,and 491 had been treated with radiation. Most of the men were in their sixties when the cancer was diagnosed and they were treated.
 
Two years and five years after treatment, most of the men were still alive. 
 
Men who had radiation treatment instead of surgery were less likely to experience urinary incontinence or erectile dysfunction. However, these problems did not get better with time. Fifteen years after treatment, almost all the men in the study reported having problems getting erections, 87 percent in the radiation treatment group and 93.9 percent in the radiation group.
These are not the only potential complications of prostate cancer treatment. A relatively common complication of treatment is bowel leakage, the inability to control bowel movements. Two and five years after treatment bowel leakage was more common among men who had received radiation treatment than in men who had had their prostates removed. By the time fifteen years had passed, however, both groups were equally likely to have bowel control problems.

Side Effects Of Hormone Treatment

Some men also receive treatment with androgen deprivation therapy, designed to counteract the production of testosterone in the testes, or combined androgen blockade, which is intended to block both the 90 percent of testosterone that is made in the testes and the 10 percent of testosterone that is made by the adrenal glands. These therapies may be continuous, given on a regular basis, or intermittent, given when laboratory results indicate the cancer is active. Continuous therapy elevates the risk of heart disease, while intermittent therapy elevates the risk of cancer progression.

Prostate Cancer: What About Watchful Waiting?

There is another approach to treating prostate cancer: Do nothing. This approach is known as watchful waiting. 
 
Researchers at the University of California at Los Angeles Geffen Medical School's Department of Urology followed 3,000 men who were diagnosed with prostate cancer in 1994 or 1995. They examined the results of treatment, or non-treatment, over a 15-year period. "Aggressive" treatments for  prostate cancer, including surgery and radiation, almost always caused major side effects, such as bowel problems, urine leakage, and erectile dysfunction. However, the survival advantage of aggressive treatment was never seen right away. It's not as if not having your prostate removed or taking radiation treatment makes a difference in whether you will die right away. The benefits of the procedures over watchful waiting generally were not evident for eight to ten years.
 
The watchful waiting (also known as active surveillance) alternative did not mean doing nothing after men were diagnosed with the disease. Men who chose watchful waiting received periodic prostate biopsies to monitor the progress of the disease. They also received radiation or surgery if the disease progressed. However, the risk of dying from prostate cancer, if it was detected in its early or even intermediate stages, paled in comparison to the risk of dying of congestive heart failure or diabetes. Of the men in the study in the watchful waiting group:
  • Just three percent who had localized prostate cancer at the time of diagnosis died of prostate cancer over the 15 years of the study, even without treatment.
  • Just seven percent who had intermediate prostate cancer at the time of diagnosis died of prostate cancer over the 15 years of the study, even without treatment.
  • However, 40 percent of men aged 60 to 74 diagnosed with prostate cancer who also had congestive heart failure or diabetes died during the study, although not of cancer.
  • Moreover, 60 percent of men 75 and older diagnosed with prostate cancer who also had congestive heart failure or diabetes died during the study, although not of cancer.
Men who are diagnosed with low-grade prostate cancer may want to weigh a three percent chance of death from cancer against a 90 percent chance of erectile dysfunction. They may also want to consider whether the risk of worsening cancer, which could still be treated with surgery or radiation, is worth the near-certainty of needing to wear protective undergarments such as Depends.
 
There is only one precaution for accepting a treatment plan of watchful waiting for prostate cancer. This treatment status still involves "active surveillance." It is still necessary to go back to the doctor for regular checkups to make sure the prostate cancer is not progressing quickly. The biopsies are unpleasant and invasive, and other medical issues may be pressing, but there is always a possibility that the cancer will progress. Prostate cancer may not need treatment for many years. As many as 72 percent of men ever diagnosed with prostate cancer will not die of the disease even if they are not treated. However, prostate cancer is not a condition a man should face on his own.

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