Making decisions at time of diagnosis

Slow down and take a breath before making any decisions about treatment.

Prostate cancer can develop into a deadly disease. But for most men at time of diagnosis today, prostate cancer is not usually in need of immediate, emergency treatment. Most likely, you'll have time -- days, weeks and in some cases months -- to gather information and to decide among several treatment options.

Even so, a recent study found that men with stage T2 prostate cancer who had to wait nine weeks or more before receiving treatment by radiotherapy had a higher rate of recurrence unless they received a higher dose of radiation.

Your first task, with your doctors' help, is to get information about your Gleason grade and stage of prostate cancer and your PSA velocity.

Your second task is learn about which treatments offer you best outcomes in long-term survival and side effects.

Medical information about prostate cancer may be new to you. Your body is on the line, and new information may be hard to absorb. This may be the most complex decision you've ever made. Do what you can to make it easier on yourself.

A few practical steps will help you to get organized and on track:

• Bring someone with you to your appointments.
• Bring a notepad and tape recorder to the appointments.
• At home, set up a calendar, a phone number book and a file box (or file drawer) and a loose-leaf ring binder.
• Use the file for your new medical records, medical bills and health insurance papers, and for print-outs from reliable sources like medical journals.
• Use the binder to list your own questions and to jot down your doctors' replies. If you prefer to use a small notebook in the doctor's office, tape your notes into the binder when you get home.
• If you wish, jot down or clip and paste in info from sources like books, pamphlets and computer print outs. Family, friends and support group members may be able to help you gather and sift information. Select the most important points that may affect you. These are points you want to discuss with your doctors.
• Nothing is too dumb (or too clever) to ask.
• If you need privacy to talk to your doctor about impact of various treatments on sexual desire, lovemaking and erections, or bladder and bowel control, say so.
• Expect any doctor you would care to allow to treat you to be interested in your overall health and well being and to see you as an individual with cancer not as a statistic or person of a certain age.
• Don't underestimate the value of statistics and "cancer numerology." Graphs and studies tell a story about human beings.
• Seek a second opinion about your biopsy.
• Seek second opinions and, if needed, third opinions or more about your treatment options.
• If you're considering either surgery or radiotherapy (external beam or brachytherapy), find a practitioner who has done the procedure many times. Usually, this means going to a major hospital recognized as a national cancer center. Prostate cancer has no single best treatment. But evidence has shown that some practitioners are "artists" and quantity of experience also counts.
       Quality of equipment used (especially for external beam radiation) is key. Urologists (surgeons) and radiologists who are leaders in their field and who have treated the most patients do a better job.
• Take some time to consider the information you have been given before you make a final decision.

In many situations in life we don't make optimal choices, "we choose the first reasonable option, a strategy known as satisficing." Satisficing is OK if there's no big penalty for choosing wrong.

In life and death situations, many people do not carefully gather all available information and come to a rational decision. A study of fire commanders found that they "took the first reasonable plan that came to mind and did a quick mental test for problems. If they didn't find any, they had their plan of action."

Some of the best cancer doctors are trained to be able to "take the first reasonable plan," do the quick mental test for problems and, if none jump out, to sell that plan of action to the patient.

But these people already know most of the available information.

Reflection

After you've gathered and studied a full range of good information, it's fine to sleep on it and let the decision come naturally.

A Dutch study has found that people can think unconsciously and -- surprisingly -- that for complex decisions unconscious thought is actually superior.

Lead researcher Dr Ap Dijksterhuis told the BBC: "The take-home message is that when you have to make a decision, the first step should be to get all the information necessary for the decision.

"Once you have the information, you have to decide, and this is best done with conscious thought for simple decisions, but left to unconscious thought - to 'sleep on it' - when the decision is complex."

It's your body and your life. You want to stay healthy, productive and active for as long as you can. More than one type of treatment might work equally well for you. For some men, no immediate treatment may be the best decision. But don't lose sight of the fact that you probably have just one good chance of a cure. It's worth bucking the urge to "satisfice" too soon. Keep reading and asking questions. Do the best that you can to make the right choice for yourself. Don't sell yourself short. Then, when you wake up with the decision "made" by your gut, or your unconscious mind, you can accept that and go forward without looking back.

This page reported J. Strax, last updated January 25, 2007

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