Introduction

In preparing this Report to the Nation on Prostate Cancer: A Guide for Men and Their Families, we had one goal: to arm you with as much as information as possible about prostate cancer and its treatments so you can work with your doctors to choose the path that’s right for you.

But achieving this goal was not easy. We knew that if we had offered a complete and comprehensive look at every treatment option, few would be interested in reading it. On the other hand, offering a brief review that did not explore the often nuanced differences between treatment options would not be helpful either.

We therefore did our best to highlight the key issues that you’ll face over the years, to focus on how the results of lab tests or scans might affect the way your cancer is managed, and to emphasize the importance of working together with all members of your health care team at every step of the way.

Fortunately, there are a variety of treatment options at every stage of prostate cancer, but new decisions about each option will be required at every step along the way. Because different therapies are offered by different specialists, we encourage you to assemble a team of specialists, including a urologist, a radiation oncologist, and a medical oncologist with whom you can discuss the different treatment options and find the path that’s right for you.

We have divided this guide into three sections, each representing a different stage of disease progression, and have included a set of tear-out sheets and wallet-sized cards for each stage that you can carry with you, summarizing key points to consider and questions to ask your doctors. (These tear-outs are only available in the pdf or paper copy  versions.) The final section gives you an opportunity to look ahead to the future, to see what the new research is focusing on, and to learn about whether enrolling in clinical trials and joining in the fight against prostate cancer might be right for you.

It is our hope that this Guide will enable you to hold meaningful, regular dialogues with the doctors, nurses, and pharmacists who have dedicated themselves to ensuring that you and your fellow prostate cancer survivors will live longer and better lives.

The first section of the Guide focuses on what to you need to know when you’ve been diagnosed with early-stage prostate cancer. In Chapter 1, we review the ways in which doctors can use the tumor samples that they’ve taken in the biopsy, your PSA, and a number of other factors to determine how your cancer is likely to act over the coming years. In Chapters 2 and 3, we go over the ins and outs of each of the different treatment options for localized prostate cancer—active surveillance, surgery, and radiation therapy, reviewing the procedures themselves and the most common side effects. In Chapter 4 , we remind you of the small but significant changes that you can make in your diet and lifestyle to keep you strong and healthy during the course of your disease.

The second section of the Guide focuses on what you need to know if your PSA starts to rise after initial therapy. In Chapter 5, we review what a PSA rise means at this stage of the disease, and describe the possible use of a second local therapy to destroy or remove the cancer that might be growing. In Chapter 6  we talk about hormone therapy—we describe the different types of drugs and how they work, and look at how doctors and researchers are working hard at trying to minimize the effects that the drugs will have on your quality of life.

The third section of the Guide focuses on what you need to know if your PSA starts to rise while you’re on hormone therapy. In Chapter 7, we explain why and how the different chemotherapy drugs are used, and review the principles of dealing with side effects from the different drugs. Finally, in Chapter 8 , we discuss the challenges that men with prostate cancer bone metastases face in their every day lives, review some of the available treatment approaches, and offer some insight into how effective pain management strategies can help them stay strong to fight their disease.

As we noted above, in the fourth and final section we look ahead to the future of prostate cancer research. Chapter 9 reviews some of the new and upcoming therapeutic approaches and treatment strategies for men with prostate cancer, and Chapter 10  describes the process by which these new treatments move from the lab to the clinic. None of these new therapies can be proven safe and effective for men with prostate cancer without the help of the thousands of men each year who enroll in clinical trials and join the fight against the disease. At each step of the way, discuss with your doctors whether enrolling in a clinical trial is right for you. Your participation can help us find better treatments and, ultimately, a cure for prostate cancer.

We hope that the knowledge you gain from the information in this Guide will enable you to be an active participant in your prostate cancer treatment planning. Remember that there is no one-size-fits-all solution or approach to treating prostate cancer at any stage of the disease. The key is to stay focused on your unique circumstances and to work with members of your healthcare team to find the treatment path that’s right for you.