Prostate Cancer: The Decision of Surgery

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Guest:  Dr. Harry Clarke – Urology

Host:  Dr. Linda Austin – Psychiatry

Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m talking, today, with Dr. Harry Clarke who is Professor of Urology here at the Medical University of South Carolina.  Dr. Clarke, I know one of your areas of expertise, and a real contribution here, is in the minimally invasive treatment of prostate cancer.  I guess the first thing to wonder about is that sometimes patients have to make a decision between having a surgery versus watchful waiting.  When we think of cancer, it’s a big scary word, why would a patient choose to wait instead of having it treated?

Dr. Harry Clarke:  One of the important things that a patient needs to understand, after they’ve had the most terrible diagnosis, of having cancer, obviously, that’s a life-changing diagnosis, a very scary thing to deal with, one of the first reactions is, I need to have this removed, or taken out, if at all possible.  But, in fact, a number of cancers, and especially a number of prostate cancers, are not life-threatening.  And, in fact, if you were to get everyone from the Citadel Mall and sample them, men of different ages, 80 percent of 80-year-old men that you just pick out of the crowd at the mall would have small focuses of cancer, and those cancers are not significant in terms of their life.  They’re not going to cause death.  It’s going to be something that they survive, in spite of the diagnosis.

So, one of the difficult things is sorting out what the significant cancers are as opposed to the insignificant cancers.  And, certainly, the other thing that’s important, related to that, is the patient’s other history, the health of the patient, his age, and the volume of the cancer that’s present.  That’s an important piece of information.

Let me take a step back and talk about how we determine what the volume of the cancer is.  Oftentimes, the patient will ask, well, I’ve got this cancer, doctor, how long have I had this?  Well, we can’t make guesses as to how long they’ve actually had it.  We can predict, by the volume of disease in the biopsies that have been taken, if the larger portions of the biopsies are positive, that would suggest higher volume disease.  If the PSA (prostate-specific antigen), the blood test for prostate cancer is higher, that would suggest higher volume disease.  So, a patient with a low PSA blood test and low percentages of cancer on the cores would be more likely to have cancer in its earlier stages.  

The natural history of prostate cancers is 10-15 years.  So, it’s not like a lung cancer, or pancreatic cancer, where a friend or a loved one is diagnosed with that and within a year or two years, they’re gone.  It’s a very slow-growing cancer.  Even the more aggressive ones are slow-growing.  So, a patient has time to study this and learn more about it and make up their mind about what the best treatment for them is.  

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