The surprising finding, after 12 years, was that there was no difference in survival between surgery and watchful waiting in the Low-Risk or in the Intermediate-Risk group.  On the other hand, men who were in the High-Risk category did benefit with improved 12-year survival when treated with immediate surgery compared to the men with High-Risk disease who did watchful waiting. 

There is no easy way to receive the news that you have cancer, but it is important to realize that prostate cancer is typically not a death sentence. In fact the vast majority of men diagnosed with prostate cancer have the low-risk form of the disease, and will live a normal life span. Even those men diagnosed with the more aggressive kind of prostate cancer have effective treatment options available to them today.

The majority of radical treatment decisions are made on the basis and results of PSA testing. PSA or Prostate-Specific Antigen, is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in the blood. Due to the dangers of overtreatment some experts have proposed forgoing PSAtesting altogether. However, this attitude is like throwing the baby out with the bathwater, since early diagnosis and treatment of high-grade prostate cancer unquestionably improves survival and quality of life.  

There is only one other form of abuse that approaches medical hexing for its pernicious influence, and that is self-hexing.  When you are diagnosed with any type of cancer it’s natural to ask, “Why did this happen to me?” Or “Could I have prevented it?” Or most pernicious, “Did I do something to bring this on myself?”

The term "adjuvant" means treatment “added to” the primary or initial treatment. When the primary treatment is surgery, even when all detectable disease is removed, there remains a statistical risk that the cancer will return due to microscopic cancer cells left behind. Men with high-risk features such as extra-prostatic extension or high Gleason score face a higher risk of recurrence.

The stress of a diagnosis of cancer can throw patients into an “altered state” in which they are particularly vulnerable to suggestion—good or bad.  And because most of us, as children, are taught to believe in the infallibility of doctors, the manner in which a doctor delivers a life-threatening diagnosis has a profound effect, and actually has the power to influence the course of the disease.

In May 2011, the New England Journal of Medicine reported on 695 men from Sweden, Finland, and Iceland, average age 65, who were randomly allocated to either immediate surgery or delayed hormone therapy (DHT) between 1989 and 1999.  The median PSA for the 695 men was 13. Eighty percent of the men had palpable disease found during their digital rectal exam. In the men treated with DHT, hormone therapy was initiated if and when bone metastasis occurred. Bone scans were performed every other year. 

As I understand it, the immune system is the body’s equivalent of the Department of Homeland Security. Its primary task is to provide constant surveillance and, when necessary, seek out “terrorists”—defective and cancerous cells—and destroy them. However, when immune surveillance breaks down or is compromised, it is usually as a result of environment pollutants, poor diet, lack of exercise, and an array of emotional suppressors.

Maybe it’s shabby of me to immediately think: It’s all about money. The pot of gold at the end of the prostate cancer rainbow. Well, the first dip into that pot is billing for all those PSA tests, DREs and biopsies. Standard screening procedures, right? Only it’s not that clear cut. More and more these days, I tend to consult with Dr. Google. Turns out there is disagreement in high places.

More and more men are embarking on active surveillance—close monitoring of their prostate cancer—rather than implementing immediate radical therapy. Of course, only individuals with carefully selected low-grade prostate cancer are eligible for this approach. During the extended observation period many men enquire if there are nontoxic interventions to improve their odds that the cancer will stay dormant. The important issue of diet often arises though that is not the subject of today’s topic. Hormonal treatment, on the other hand, is a treatment that calls for further discussion.