After covering the latest research suggesting that men with early stage, non-aggressive prostate cancer who were treated with immediate surgery didn’t live any longer than those whose cancers were merely monitored, I received several emotional e-mails from readers.
One wrote, “Had this been an article on breast cancer, the Susan [G.] Komen people would have been, rightfully, all over it. … I shudder to think of the cancer victims that this so-called ‘study’ may have unduly — potentially fatally — influenced.â€�
Another man wrote that he’s certain he benefitted from his prostate cancer treatment eight years ago: “I owe [my doctor] my life for an early detection and to an outstanding urologist who has a national reputation for effective surgery. I was told that doing nothing was an option, but found I could not live with the knowledge of an active cancer, regardless of its rate of growth.�
I also received an e-mail from a 60-year-old man struggling over whether to have a biopsy after being informed that his prostate-specific antigen (PSA) level had risen ominously on his annual screening test. He wanted to know the likelihood that a man his age with a PSA level of 5 nanograms per milliliter would have a biopsy indicating cancer. I tried to find a study to better guide him but didn’t come up with too much in my literature searches — nor, he wrote in a followup e-mail, could his urologist at MIT Medical.
With all the comments I’ve received on my previous coverage of prostate cancer issues and the dilemma over PSA screening, I’ve never, though, heard from a reader who has regretted being treated for his cancer — until now.
Walter Chorney of North Attleboro told me in an e-mail and subsequent phone conversation that he regretted having radiation treatment for his early stage prostate cancer, after experiencing pain and bleeding for 19 months after treatment. Nearly three years ago, Chorney was told, at age 67, that his elevated PSA of 2.7 ng/ml required him to get a biopsy.
Only one tissue sample out of 12 taken showed cancer, but the cancer was deemed to be moderately aggressive based on the look of the cells under the microscope.
Chorney consulted several doctors at Boston-area hospitals, and some suggested surgery, while others advised radiation. None recommended that he do what he actually preferred: surveillance of the cancer with no immediate surgery or radiation.
“I asked about it and they said, no, you have to do something,� Chorney told me.
After doing online research and interviews with prostate cancer specialists, Chorney said he settled on radiation treatments using a newer robot-assisted technique called Cyberknife that targets only the tumor without destroying the entire prostate. He was comforted by the low rate of side effects; the website said moderate to severe urinary problems occur in “0 to 3.5 percent� of patients and bowel problems occur in “0 to 2 percent� of patients.
That’s far lower than side effects seen with traditional surgery or radiation techniques. (Then again, the Cyberknife technique hasn’t been as widely studied, so its unrealistically low rate of side effects — zero as the lower end of the range is suspicious — may be underestimated.)
Regardless, Chorney was one of the unlucky ones who experienced lingering symptoms after his five rounds of radiation treatments over the course of a week. He had severe abdominal pain, bleeding when he urinated, and the urge to void his bladder every 20 minutes. Once he was nearly arrested after he pulled his bike over to the side of the road to urinate during a four-mile ride to a store.
“I was miserable for over a year,� Chorney wrote to me. “The radiation killed the small amount of cancer but zapped me physically and mentally.�
He finally found relief this past January after having surgery to reduce the size of his prostate, which had become enlarged following the radiation treatments. (His doctors suspect that the enlarged gland occurred from damage from the radiation, but they don’t know for certain.)
“I regret having my prostate cancer treated,� he said. “My gut told me that I did not need any treatment but the experts told me that I did. If I was diagnosed today I think my doctors would have been more willing to let me choose monitoring.�
Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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