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| Lenny Hirsch, Israeli prostate cancer survivor and support group founder and activist. |
Unfortunately, in many cases the answer is no. I am receiving phone calls on a weekly basis from men with horror stories of doctors prescribing various treatments without informing the patient of possible side effects or not telling them of the choices of treatment.
I wish to point out that in most cases prostate cancer is very slow growing. Nearly all men diagnosed with PCa have had the disease for a number of years. Statistics show that over 80% of men over the age of 75 were found to have PCa, but died of unrelated causes or old age. This information was gathered when autopsies were performed. The conclusion that should be drawn is that there is no need to rush into treatment before learning all you can about the illness.
Get a second or third opinion!
Ask questions and demand answers
Join a support group and speak to other men who have or have had Pca
Take responsibility for your body
Knowledge is the best weapon in this war.
The quality of your life can be seriously impaired. Two percent of men with PCa might die of the disease, yet thousands are walking around to-day as sexual cripples, depressed, without control of their bladders. Marriages, in many cases, are strained. All because of hasty decisions, lack of information of the proposed treatment or negligence on the part of the doctor.
Below are a few of the incidents that have recently come to my attention.
1. A seventy-eight year old was found to have a PSA of 10. There was no follow up PSA. A biopsy was performed which showed a Gleason score of 3+3=6. He was immediately given the hormone Zoladex and arrangements are being made for radiation treatment. The man was not told of the possible side effects. He lives alone and can no longer cope with the day-to-day things that he did before the hormone treatment was started. The doctor involved has the reputation of being the best urologist in Jerusalem.
2. A newly diagnosed member of my support group came to me for advice. I asked him how he was coping with the hot flushes, loss of libido, fatigue, failing memory and possible lack of motivation. He looked surprised and asked how I knew what he was experiencing. On being told that I read that he was on hormone therapy and these were some of the side effect, he burst into tears. He said that he was not told and thought that the cancer was causing these problems. The doctor in this case is the department head of a clinic in Haifa . I have met men with similar stories about this doctor. Maybe he, the doctor, should be injected with Zoladex.
3. Another member of my support group was thought to have PCa four years ago. A biopsy was found to be negative and he was told to go home and forget about the possibility of cancer. He took the doctor's word and did not give the possibility of Pca a second thought. Recently he had a PSA test which was sixty four. Another biopsy gave a Gleason Score of 4+3=7. He is now undergoing hormone therapy to be followed by radiation. We are hoping that the cancer has not spread out of the prostate and that the treatment will get it all. Four years ago he should have been told to have his PSA checked every 3 months. In this way he would have more options of treatment and a better chance of getting rid of the cancer. The culprit in this case was the urology department of the Emek Hospital, Afula.
4. A man in the center of the country contacted me for advice. His PSA had risen from 2.5 to 3.4. He had a biopsy 3 years ago which showed an extremely low Gleason Score 1+2=3. When his urologist saw the increased psa, he recommended that the man immediately see an oncologist. The oncologist ordered the patient to go onto hormone therapy to be followed up by radiation. This man spoke to me after receiving his first injection. I was shocked. The oncologist is supposed to be one of the top experts on PCa. There was no need for him to go to an oncologist and definitely not to undergo hormone therapy. This was later confirmed by an expert urologist that I referred him to. After performing a DRE the urologist said that he did not feel anything wrong with the prostate and that he recommends that the man does not under go any further treatment. He should have a PSA test every 6 months after the effects of the hormones wear off.
5. An urologist who is second in charge of the urology department of a big hospital in the north sends men for a biopsy without performing a digital rectal examination. The accepted practice throughout the world is that a man is only sent for a biopsy on information gained through the PSA and the DRE. A high PSA does not necessarily indicate cancer. Why must men be subjected to the discomfort of a biopsy and the tension that they and their families experience waiting for the results?
6. There is no information published about the success or failure of hospital treatments. How can the patient make a decision on what treatment to opt for or which hospital has the best record of treatments and minimum side effects.
I am not suggesting that all the doctors are not to be trusted. Most doctors treating this terrible disease are devoted and caring people working under very hard conditions. However they are human beings and can make mistakes. For this reason it is up to you to learn about every thing you can before making a treatment decision.
Again I stress the importance of a support group. To my knowledge, in Israel there are only two. Here are the contact numbers;
Tel Aviv; 0528300467
Haifa and the north 0544570595
I know that the above is very controversial. I have made it my mission to correct the wrongs that are inflicted on PCa patients in this country.
Lenny Hirsch, Moshav Ben Ami
July 2005
