Prostate Cancer: A Survivor's Guide

Introduction: The Journey Ahead

by Don Kaltenbach


When I was first diagnosed with prostate cancer in 1990, easily accessible information was sadly lacking on the nature of the disease and the alternatives that patients possess for treatment. That situation has changed dramatically with the growing number of books, news articles, reports in medical journals, and a multitude of Web sites that are devoted to prostate cancer. There is now more information available than ever before, so much so that the patient is challenged to wade through it all to keep up with the latest advances in diagnosis and treatment. The primary goal of this book is to provide the most reliable and up-to-date findings, and to help the patient understand how to process that information so he can work with his doctor to decide on the best course of action.

Prostate cancer is much more than a technical description of a disease and its available treatments. It is a journey. More than thirteen years ago, I made that journey, from discovery to recovery. It is my hope that reading this account of my experiences will provide you with an expectation of what your own journey may hold for you. In this sense, by calling this book "a survivor's guide," I mean more than just a source of useful information. I myself am a survivor who has made the difficult, sometimes harrowing passage from one side to the other. My hope is that this book will provide direction for those who also must come this way, to make the road easier and the destination more sure.

Foreword

by Michael J. Dattoli, M.D.
If you have recently been diagnosed with prostate cancer, the first thing you need to know is that there is no reason to panic. Prostate cancer is a very common disorder in this country with more than 200,000 men diagnosed annually. Unlike other cancers, such as lung cancer or colon cancer, prostate cancer is typically more curable. And because this form of cancer is usually slow-growing, you have time to learn about the disease and the various treatment options that are available to you. This book, written by prostate cancer survivor Don Kaltenbach, will provide you with the tools to work with your doctor and become an integral part of the decision-making process.

Despite the gravity of a prostate cancer diagnosis, there is plenty of good news to report about this disease today. First, although statistics show prostate cancer is on the rise, we know much of this is due to a dramatic increase in early detection. Screening procedures are more common, and heightened public awareness has encouraged more men to ask their doctors to be tested. Second, extensive research in this field of medicine during recent decades has led to great advances in treatment and care of prostate cancer patients. And third, these new treatment options -- the most remarkable of which are called brachytherapy (pronounced "brak-e-therapy") and Intensity Modulated Radiation Therapy -- have profoundly improved our ability to maintain quality of life for patients.

It may seem at first that you face a bewildering array of treatment options. The earlier you are diagnosed, the more options you are likely to have. The number of treatments available is part of the reason this area of medicine remains controversial, as doctors continue to disagree over which form of therapy is best. The fact is that regardless of which treatment a patient selects, he has a reasonable prognosis, which is unlike most other cancers. With prostate cancer, there are a variety of specialties offering treatments -- radiation, surgery, hormonal therapy and so forth -- all of which can potentially knock the cancer out, at least for a while.

In the weeks and months ahead, you will need to decide which treatment is best for you. Becoming an informed patient is half the battle. As a patient, Don Kaltenbach asked questions and researched his treatment options. His efforts to inform himself led to the writing of this book. Don’s story is not uncommon. His concerns about the possible complications of radical surgery influenced his choice of therapy. At the time Don was diagnosed in the early 1990's, surgical removal of the prostate was considered the standard treatment for early stage prostate cancer. That situation has changed dramatically, with more and more patients like Don opting for various forms of radiation therapy, which has now proven equal to or more effective than surgery but with a lower risk of serious side effects.

Don ultimately chose brachytherapy, a non-invasive procedure that involves the implantation of radioactive seeds in the prostate to kill the cancer. This is one of the procedures I utilize in my practice at the Dattoli Cancer Center, where Don now serves as Executive Director. I often combine brachytherapy with the most sophisticated form of external radiation therapy, known as Intensity Modulated Radiation Therapy (IMRT). Even higher risk patients (those with high PSA values and/or high Gleason scores) have enjoyed a survival rate in our program approaching 80% over ten years, while low risk patients have a success rate greater than 90%. I have been performing prostate brachytherapy since the mid-1980's and continue to follow patients from that period. I now have every reason to believe that the vast majority of prostate cancer patients can be cured by this state-of-the-art, combined approach, which is the emerging ‘gold standard’ treatment for prostate cancer.

In my practice, I like a patient to be very comfortable with his treatment. The patient who has become informed and knows what to expect will come through his treatment with more practical knowledge and more peace of mind. Sometimes I can tell that a patient is not going to be comfortable with anything but surgery. When I sense that is the case, I tell him that if his test results indicate that his cancer is still confined to the prostate gland, perhaps he can undergo surgery. I try to be as even-keeled as possible about all the treatment options. The choice is his. It may sound very logical to say you have a cancer, and we should remove it by cutting it out. But if the patient is also told there is a high probablity that cancer will be left behind after surgery, that he may have to wear diapers for the rest of his life and there is a strong probablility that he will be impotent, the patient may want to think very hard about it. In the end, whatever he decides, the patient should feel confident that he has made the right choice for himself.

As related in this guidebook, Don’s experience demonstrates that weighing the pros and cons of each treatment option -- considering both the probability of cure and the risk of potential side effects -- is key to the decision-making process. Don’s personal story also shows that the emotional burden of coping with cancer can be as much of a challenge as the physical impact of the disease. Regardless of which treatment you may choose, the reassuring advice and encouragement that Don offers in these pages can help you cut through the confusion and successfully come to terms with the disease.