Talking With Your Medical Team
Learning as Much as You Want to Know
Thinking About Your Feelings and Values
Talking With Others
Asking Questions
Making a Choice

Most prostate cancers found in the early stages grow slowly. This means that you usually do not have to rush when making a treatment choice. Often, you have several weeks to several months from the time you first learn you have prostate cancer until you have to make a choice.

Many men use this time to find out more about prostate cancer treatment options. Be sure to find all of the information you need to answer your questions and be comfortable with your decision.

It may be helpful to use this extra time to attend a prostate cancer support group to talk with other men who have faced the same decision-making process. The Resources Section lists the National Cancer Institute's toll-free numbers to call and request contact information for prostate cancer organizations.

Studies show that men felt better about their treatment decision when they took part in making their own treatment choice. But making this choice can be hard to do. The following are some ideas that may help.

Talking With Your Medical Team

Here are some things to keep in mind:

• Questions. Ask your doctor or nurse questions that you are thinking about, but that you normally may not feel comfortable asking. These questions can be about topics that are new to you or side effects that concern you. For example,"How many operations (prostatectomies) do you do a month?"Make sure you understand the answers, or ask your doctor or nurse to explain in other ways such as with pictures, models, or charts. (See Asking Questions for a list of key questions to ask.)
• Health history. This includes your age, family history, health (other than cancer), and whether you have any other illness, such as diabetes or heart problems, or have had a previous prostate surgery.
• Cancer history. You will talk about your prostate cancer in terms of PSA number, grade, Gleason score, and stage. This means size, location of the cancer, and what it looks like under the microscope. (To learn more about these terms, see Medical Tests and Terms)
• Treatment choices. It's important to ask your doctors about all the treatment options that are available to you. This includes benefits (how each treatment can help) and long- and short-term side effects. This may even include the small risk of death from surgery.
• Your part in making a choice. Men who actively take part in their treatment tend to have fewer regrets than men who let others decide for them. Let your health provider know how active you want to be in making this choice.
• What is important to you. Keep in mind what's important to you and what worries you. This is also a good time for you and your spouse or partner to have an open, honest discussion with each other about your treatment choices and their side effects.
• Ask a family member or trusted friend or caregiver to come to appointments with you. This person can help listen, ask questions, take notes, and talk with you about what your doctor or nurse said.
• Bring a copy of your pathology report. Make sure to ask your doctor for a copy of this report and bring a copy with you when you see new doctors. Your pathology report includes the results of tests that describe details about your cancer. If you are seeing a new doctor, it's important to bring all the information he or she requests to your visit.

"Investigate all your options and be comfortable with the choice you make, because you can't second guess when it's all over." - Lawrence

• Get a second or even third opinion. Seeking other opinions means talking about prostate cancer treatment with doctors you are not working with now. You may want to talk with other prostate cancer specialists, such as a urologist, urologic oncologist, surgeon, medical oncologist, internist, or radiation oncologist.

  Getting second and third opinions can be confusing, because you may get different advice or opinions. Because of this, many men find it helpful to see a medical oncologist for a general view of prostate cancer treatment options. Talking with other doctors can give you ideas to think about or help you feel better about the choice you are making.Most insurance companies pay for second opinions. It is better to get a second opinion than worry that you made the wrong choice.

  "When you are faced with a medical decision like this, you almost want to put yourself in the hands of the expert. But it's really a decision that you have to make, and you have to make it on an informed basis and seek out more than one opinion from a doctor." - Paul

  Learning as Much as You Want to Know

  Many men with prostate cancer find that it helps to learn a lot about their disease and its treatment. Doing so can help you feel more in control and at ease with your treatment choice.

  You can learn more by reading books and articles, searching the Internet, or calling organizations that focus on prostate cancer. But too much information can sometimes be overwhelming or confusing as you are adjusting to your diagnosis. Instead, learn as much as you want to know at a time when you are ready. Later, you can always find out more. Let your doctor or nurse know what else you need to know to be comfortable reaching a decision.

  Some men want to read books and articles that outline the current research on prostate cancer treatment options. Others prefer to meet with men at support groups who have had prostate cancer to learn how they made their treatment choices. Some men may not want information or want to talk about it at first - only later are they ready for more information. All of these approaches are natural reactions to coping with a diagnosis of prostate cancer.

  For more details, see the fact sheet "How to Evaluate Health Information on the Internet: Questions and Answers" at www.cancer.gov, search term "Internet." Also see Resources for more information.

  Thinking About Your Feelings and Values

  It's natural to feel many emotions at this time. Sometimes you may have many strong feelings at once, while at other times, you may feel overwhelmed or angry. Your spouse or partner will also feel a range of emotions but may not have the same emotions at the same time as you do.

  A diagnosis of prostate cancer can stir up many feelings, such as fear of the cancer getting worse or of dying. You may also worry about changes to your body or being intimate with your spouse or partner.Many men describe a feeling of loss - loss of the life they had before cancer, loss of energy levels, or the physical loss of the prostate. These feelings are a natural part of the coping process.

  Your spouse or partner may be worried about losing you, changes to your lives, and how to best give you the support you need. They may want to talk about it more than you want to at first. If you find that you need time to adjust and sort out your feelings and values, let your spouse or partner and family know your needs. Chances are that they are also trying to cope with the news and may not know how best to help you. If you are holding your worries and feelings inside for too long and your silence is hurting you or your family, ask your doctor, counselor, or religious leader for suggestions about getting help.

  Reaching a decision on how you want to treat your prostate cancer is very personal - it is a blending of what is important to you, what you value the most, what types of treatment options are available to you, and what the benefits and side effects are.

  Talking With Others

  Along with talking to their health professionals and spouse or partner, many men find it helpful to meet with others and talk about treatment choices. For example, you might want to meet with:

  • Family. This includes your relatives and close friends who care about you. Your family can support your choice about treatment.
  • Men who faced prostate cancer. There is a lot to learn from other men who faced these same prostate cancer treatment decisions. You may want to join a support group or meet with others to talk about the choices they made and what life is like now that treatment is over. Remember that while your prostate cancer may be similar to someone else's, your life and desires may be very different.
  • Others who can help you. You may have other people in your life who can help. This may be a close friend, neighbor, counselor, social worker, or religious leader you like and trust.

  Asking Questions

  You may find it helpful to ask the following questions:

  Could you write down my exact type of prostate cancer?

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  May I have a copy of my pathology report?

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  If I wish to have another pathologist look at my prostate biopsy, how do I get the slides?

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  What is the clinical stage and Gleason score of this cancer?

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  What treatment option do you recommend?

  • Watchful waiting
  • Surgery (What type, can the nerves be spared, and how often do you do this procedure?)

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  • Radiation (What type do you use, and what can be done to minimize side effects?)

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  • Other

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  What are the short- and long-term side effects of this particular treatment?

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  What are my chances of:

  • Becoming incontinent

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  • Becoming impotent

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  • Having other urine or bowel problems

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  What are the chances of the cancer coming back if I have this treatment?

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  What is the expected survival rate?

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  Making a Choice

  "Prostate cancer gives you the opportunity to make a deliberate, considered choice. In the majority of cases, the disease is very slow growing and is never a medical emergency.

  With prostate cancer, you have ample time to assess the situation, evaluate your particular needs and resources, and devise the most sensible, strategic plan of action.

  Doctors can and should help you to understand your medical situation, but only you can decide what trade-offs you can tolerate, what level of risk you find acceptable, and which potential sacrifices you're willing to make."
  - Dr. Peter Scardino, Chairman of the Department of Urology, Memorial Sloan Kettering Cancer Center

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