Written by admin on 2009-03-30T07:52:40+0000">March 30, 2009 – 7:52 am
So: If a man has localized disease, the big, blunt question is, How long is he probably going to live? Nobody wants to think about this question, but there it is. Let’s go back to our 65-year-old man. He’s in otherwise good health, and he can reasonably expect to live at least ten more years. His cancer is curable now. If he does nothing about it, if he opts for watchful waiting, he may miss his golden opportunity for cure. Remember, right now we have no way of estimating the biological potential of prostate cancer. We can’t determine if it’s harmless or deadly; we don’t know if or when it will make that fatal leap beyond the prostate. Even in its earliest stages, prostate cancer doesn’t always spread considerately, in logical, creeping, easy-to-predict steps. And unfortunately, men with the earliest stages of prostate cancer can have metastases before they ever even develop palpable cancer that can be felt by a doctor’s gloved finger during a rectal examination.
At the other end of the spectrum is the man in his eighties. Even if his cancer is organ-confined and curable, it’s not likely that he will live long enough for major treatment to be worthwhile. Older men are less resilient; aggressive treatment is much harder on them. What’s the point of risking incontinence (a result of surgery) or rectal bleeding (a result of radiation) in an 85-year-old man? If his disease progresses to the point where he has difficulty with urination, there are many ways to treat such symptoms (ranging from a TUR to hormonal treatment). For most older men, the number of years of life—the long-term survival—is not nearly as important as the life in those years—the quality of life.
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