Читать книгу Saving Your Sex Life: A Guide for Men With Prostate Cancer - John P. Mulhall - Страница 21

After the initial shock of being given a diagnosis of cancer, you will need to start grappling with decisions regarding treatment. The treatments outlined in this book include watchful waiting (where no specific therapy is undertaken), radical prostatectomy surgery and radiation therapy, either in the form of implantable seeds (brachytherapy) or external beam radiation in a number of forms.

It is prudent to take your time when making decisions about prostate cancer treatment. While patients are understandably stressed and distressed by their diagnoses, the good news is that prostate cancer is a relatively slow-growing cancer in the vast majority of cases. Once you have been biopsied, your surgeon will be able to tell you how many of the cores on the biopsy were positive and what the volume of cancer is within each core and in the entire set of specimens.

The pathologist will also grade the cancer. The grading system most frequently used is the Gleason grading system, which identifies the major and the minor patterns and is scored from 1 to 5, where 5 is the most aggressive cancer and 1 is the least aggressive cancer. The majority of men are in the Gleason 6 (3+3) range, a large number are 7 (3+4 or 4+3), very uncommonly we see Gleason 8, 9 and 10, and likewise, rarely do we see Gleason 5 or 4. Gleason cancers that are 5 or 6 are moderately differentiated. Gleason 7 cancers are deemed to be of intermediate aggressiveness, and Gleason 8, 9 and 10 are highly aggressive cancers. In general, the higher the Gleason grade, the greater the concern the physician will have about the prostate cancer growth.

It is important to understand that the vast majority of men who have prostate cancer are curable and may go on to live many years after treatment. These men may also live with the complications of their treatments. The literature comparing radiation, surgery and watchful waiting is largely murky. There is evidence from a large Swedish study that shows that there is a survival advantage to men undergoing radical prostatectomy. There is also evidence that seed implantation is less effective for patients with intermediate-or high-grade cancers, Gleason grades 7 through 10.

Only you and your partner, should you have one, can make the final decision. It is likely that a good physician will give you options and you will have to make decisions regarding these based on a risk-benefit analysis. Risk benefit analysis means that you will review the extent and the aggressiveness of the cancer and compare it to the side effects of the respective treatments.