Andrew Siegel MD 2/23/19
A thank you shout-out to Dr. Stephen Peters, Director Anatomic Pathology Rutgers-NJ Medical School, for helping me to distill the complexity of cancer into simple and understandable terms.
Attribution of image above: Alpha Stock Images – http://alphastockimages.com/
One’s response to hearing the four words: “You have prostate cancer” is often predictable, although every reaction is unique. The initial feelings are usually shock, disbelief, confusion, numbness and even denial. Concerns and questions immediately surface, prompted by lack of information and fear of the unknown and of what the future might hold: How can this be possible? Why me? How can this be when I have no symptoms or pain? Is this an error? Was my pathology report confused with that of another man? What is my prognosis? Can I be cured? Will I be alive to see my children married? How will treatment affect my lifestyle? Will I be able to continue functioning as a man? Will I lose urinary control? How long do I have to live? How is this going to affect my ability to work?
One of my patient’s responses was noteworthy—in a rich Irish brogue: “Jesus Christ, I’m going to go back to drinking and smoking.”
When a man is told he has the “C-word”—one of the most loaded words in the English language—his reflex response is often to want immediate action against such a potentially life-altering diagnosis that is capable of stealing precious time from the days he is granted on this planet. However, immediate action is neither desirable nor necessary since in most cases “time is on your side” and it is important to allow a sufficient period of time to become educated and informed about prostate cancer and to process the diagnosis and the various treatment options.
One’s reaction will continue to evolve over time and most men will experience discrete emotional stages, similar to those experienced during the process of grieving (do you remember Elisabeth Kubler Ross and her stages of grief?). Shock is followed by anger, distress, anxiety, irritability, sadness and perhaps depression and feelings of powerlessness. During this period, it is not uncommon to feel overwhelmed, lethargic and fatigued. Many men experience difficulty concentrating, insomnia and lose interest in sex.
Ultimately, one comes to terms with and accepts the reality of the diagnosis, particularly with the realization that most men with prostate cancer will go on to live long and healthy lives with fewer side effects than in previous years because of advances in treatment. Although prostate cancer can be a deadly disease for some men, it has one of the highest survival rates of any cancer, with a 99% 5-year and a 96% 15-year survival rate.
What exactly is cancer?
Cancer is the uncontrolled and disorganized growth of abnormal cells, as opposed to the controlled and organized means of replacing old cells after they become non-functional. Whereas normal cells grow, divide and die in an orderly fashion, cancer cells continue to grow, divide and form new abnormal cells.
Normal cells become cancer cells (malignant cells) when permanent mutations in the DNA (deoxyribonucleic acid) sequence of a gene transform them into a growing and destructive version of their former selves. These abnormal cells can then divide and proliferate aberrantly and without control. Although damaged DNA can be inherited, it is much more common for DNA damage to occur by exposure to environmental toxins or from random cellular events. Under normal circumstances, the body repairs damaged DNA, but with cancer cells the damaged DNA is unable to be repaired.
As cancer cells grow they form a mass of cells (1 cubic centimeter of cancer consists of about 100 million cells) and the properties of the mutated cells allow them to encroach upon, invade and damage neighboring tissues. They can also break off from their site of origin via blood and lymphatic vessels and travel to and invade remote organs including lymph glands, liver, bone and brain, a situation known as metastasis.
The first goal in prostate cancer is for early detection–before the events described in the preceding paragraph have a chance to occur–to enable cure of the disease. The second goal is to accurately ascertain risk to predict the potential for aggressiveness and severity, since every cancer has a unique biological behavior. Using risk assessment tools, any given prostate cancer can be categorized into one of five risk categories with a determination made of who has aggressive disease that requires treatment and who has indolent disease that can be managed with surveillance. The third goal is cancer control with preservation of urinary and sexual function in those who have been determined to have potentially aggressive disease that merits treatment.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.
The content of this entry is excerpted from his new book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families
Preview of Prostate Cancer 20/20
Dr. Siegel is the author of 4 other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Our Greatest Wealth Is Health 