47-Year-Old Dad’s Routine Blood Pressure Check Leads to Prostate Cancer Diagnosis and Surgery How to Make Important Treatment Decisions

“I was only 46 and didn’t experience any symptoms that would suggest I had the disease, so I was in total shock,” the dad of two said of his diagnosis. “I’m usually someone who looks for a joke in any situation, but not this time.

“I was sitting in the room probably five minutes before I was told about it. Then after that, it just doesn’t sink in. You’re just in a blur, so I didn’t break down right away. It was more shock, if anything.”

The blood test had detected that his PSA (prostate-specific antigen) levels were abnormally high, inspiring further testing.

Prostate-specific antigen (PSA) is the name of a protein secreted by the prostate gland. Men have a small amount of PSA in their blood all the time but large amounts may signal that something is brewing. When cancer cells grow, PSA spills into the blood.

“I had no idea what a PSA level was,” Saunderson explained.

“I was then asked to go for a rectal exam, and from that exam it was identified that my prostate was enlarged. I had a couple of MRI scans; I had a biopsy taking samples from my prostate, and it was identified I had stage two cancer.”

When Should I Get Tested for Prostate Cancer?

Once it came time to make treatment decisions, Saunderson talked with his care team and his wife. He eventually decided that surgery to remove his prostate gland would be the best path for him.

“Originally I was thinking we could monitor it, but the anxiety was getting to me, every day waking up thinking I’ve got cancer inside me, and is it going to get to a point where it spreads and there’s nothing more they can do,” he said. “I 100% feel I made the right decision. For my own peace of mind, I think it was the right thing to do.”

How Do You Treat Early Prostate Cancer?

Treatment for early-stage prostate cancer can vary greatly from person to person. And some people might not even need measures like prostate removal or radiation.

RELATED: People With Low-Risk Prostate Cancer Can Rely on Monitoring the Disease Without Increasing Risk of Death in 15 Years How to Make the Important Decision for Treatment

The Challenge of Deciding When to Treat Prostate Cancer

Men with early-stage prostate cancer that has a low risk of spreading may decide with their doctors not to undergo aggressive treatment at first and instead monitor the disease for changes (just as Kevin Saunderson indicated). There are two methods that may be used:

Watchful waiting (or observation) is when a patient's condition is closely monitored and no treatment is given until signs or symptoms appear or change.

Active surveillance is a similar option but includes more routine testing and follow-up that watchful waiting. This involves the close monitoring of a patient's condition without giving any treatment unless there are changes in test results. With this option, patients undergo regular PSA tests and rectal exams, and possibly biopsies and imaging scans.

"The concept of active surveillance is you're watching a man, and if something changes while the cancer is still in the prostate, you treat it then," Chief of urologic oncology at Stanford Medicine Dr. James Brooks said.

"An ideal man for active surveillance might be a man, for instance, in his late 60s who has a barely elevated PSA, let's say just above 4, who undergoes a biopsy and is found to have one of the 12 biopsy cores with a small percent of low grade, what we call, Gleason grade 3 plus 3 prostate cancer.

"That man has a very low probability, it's certainly less than 1% chance, of dying of prostate cancer in 10 years."

The Benefits of Active Surveillance

Active surveillance usually involves:

• A PSA test every six months
• Repeat digital rectal examinations no more frequently than once a year
• Repeat biopsies no more frequently than once a year.

With active surveillance, the biggest plus is that you get to preserve your normal functioning.

"You don't have to suffer some of those potential side effects” of surgery, like “sexual dysfunction or urinary dysfunction," Dr. Brooks said.

Still, people who start with active surveillance might need treatment later on. According to Dr. Brooks, about 50% of men will have changes within five years that necessitate active treatment.

Still, recent research supported that men who managed their low-risk disease through monitoring did not have an increase in their risk of death in 15 years, highlighting that radical intervention such as prostate removal or radiation and the side effects of those treatments may not be immediately needed.

When early-stage prostate cancers do require treatment, local options like surgery and radiation may have a curative effect.

Don't Believe the Hype: Do Your Own Research on Prostate Cancer Treatment

Surgery options include traditional open surgery, which requires a large incision, and laparoscopy, which is more commonly used today and requires a smaller incision and a shorter recovery time.

Robotic-assisted laparoscopic prostatectomy (RALP), or robotic surgery, is a newer option where surgeons are able to make small incisions more precisely.

Surgery for prostate cancer may cause side effects, so it’s important to talk to your doctor about those before making a decision. Most men will have temporary leakage or erectile dysfunction, but the vast majority will regain nearly normal function in both areas with time.

In addition, men undergoing surgery for prostate cancer should know that shrinking of the penis is also a potential for side effect for some.

Your doctor may be able o recommend treatments or methods to help manage these side effects.

RELATED: How to Choose a Surgeon Does Volume Matter?

Radiation is another treatment option that can be done via:

• External beam radiation: a non-invasive form of radiation meaning no tools are needed to break the skin or physically enter the body where high doses of radiation are administered to the tumor.
• Brachytherapy: an internal form of radiation that requires small radioactive seeds to be placed in the prostate either temporarily at a high dose or permanently at a low dose.

RELATED: The Benefits Of High-Dose Brachytherapy: Temporary and Fast

Will Prostate Cancer Surgery Side Effects Be Long-Term?

"Over the last ten to fifteen years, we have done remarkable things with our technology that allows us to aim much more carefully, reduce the amount of radiation that nearby critical structures get, and thereby get a higher dose in a quicker period of time," Dr. Patrick Swift, a radiation oncologist and a Clinical Professor of Radiation Oncology at Stanford, said.

In addition to the above options, there are also other treatments for early-stage prostate cancer that are either new or currently being tested. That’s why you should always have a comprehensive conversation with your doctor about all potential options so you feel confident about whichever one you choose.

Making a Treatment Decision With Your Doctor

It’s important to talk with your doctor about your concerns and questions as you make your decision on how to treat your prostate cancer.

Weighing the risk of potential side effects with the benefits of a certain treatment path can help you make this important choice.

"Patients and physicians need to understand the surprising concept that prostate cancers are not all the same. Whether prostate cancer needs to be treated or monitored, depends on multiple risk factors," Dr. David Wise, director of genitourinary medical oncology at NYU Langone's Perlmutter Cancer Center, previously told SurvivorNet.

It's important to discuss your specific circumstances with your doctor to understand the best options available to you. For example, the incidence of prostate cancer in African-American men is 60%  higher, and they are two to three times more likely to die from the disease. That's in part because they tend to get a more aggressive form, and they are also more likely to be diagnosed at a more advanced stage.

In addition, while the risk of death was comparable across the three treatment plans surveillance, surgery and raditation that could be because those with higher risk disease were treated appropriately. This means that active surveillance may be appropriate for some but not for others.

"The risk of the cancer is the key take home message from this trial," Dr. Wise added.

"Low-risk cancer can be safely monitored. Advances in monitoring on a formal active surveillance protocol with a urologic oncologist should be strongly considered. Surgery and radiation should only be considered after a discussion of the risks and benefits of these treatments given the lack of survival benefit reported in this study and others."

It's important to note that active surveillance requires regular, close monitoring. It is dependent upon the patient taking some charge of their care and responsibly showing up for their appointments and getting their lab work done.

If this seems like a treatment plan that would not be possible for you (for logistical or other reasons), then active surveillance may not be the right choice for you.

Questions to Ask Your Doctor

If you have been diagnosed with low-risk, early-stage prostate cancer and are considering your treatment options, here are some questions you may consider asking your doctor:

• Do you think I would be a good candidate for active surveillance?
• What routine tests would be part of your active surveillance plan?
• What other treatment options are available to me to treat the cancer?
• What are the potential side effects of those treatments?
• Do you have methods to help manage those side effects?
• Do those side effects outweigh the benefit of that treatment for my type of prostate cancer?
• I’m struggling to cope with my diagnosis, are their mental health resources available to help me?

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