OMG!  My Treatment is Delayed! 

So, you’ve got localized prostate cancer, you’ve decided to get it treated with either surgery or radiation, and you have steeled yourself to just bite the bullet and get on with it.

You’ve been through a lot already: the PSA and physical exam, the biopsy, and just coming to terms with the fact that you have prostate cancer.   You did your research, decided on the right treatment, found a good doctor, and you’re all ready to go – and, looking past the treatment and recovery, you’re looking forward to getting on with the rest of your life.

And now there’s a global pandemic.  OMG! 

At many hospitals around the country, non-emergency procedures have been bumped, including treatment for localized prostate cancer.  And maybe you’re feeling a little stressed by this, or even flat-out panicky, thinking that cancer’s ticking away inside your body like a time bomb – or like the creature that burst out of John Hurt’s chest in “Alien.”  You’re not alone.  I recently wrote about this for the Prostate Cancer Foundation’s website, pcf.org., because so many men are worried about treatment delays.

Hold up there, friend:  a few weeks is not going to mean that your golden opportunity for a cure has closed.  Let’s take a deep breath and think about this:

First, nobody, ever, has instant treatment for localized prostate cancer.   The reason is that your prostate must heal after the supreme insult of having multiple needles stuck in there and little bits of tissue removed.  After the biopsy, the prostate is riddled with tiny holes – like perforated paper.  And, like perforated paper, it’s easier to tear, which means it will be more difficult to remove that damaged tissue in surgery.  Also, it’s inflamed; it’s not going to respond the same way to radiation, and it’s going to be a lot more difficult for a surgeon to operate.  If there’s swelling, or if the tissue inside the prostate is adherent to the rectum – a common, temporary occurrence after biopsy – the surgeon may inadvertently leave cancer cells behind.   The inflammation needs to heal and the punctures need to heal.   That’s why you have to wait a minimum of six to eight weeks after biopsy before you can get surgery or radiation.

“We have studied hundreds of patients who underwent surgery and evaluated the delay between diagnosis and cure,” says my longtime coauthor, Johns Hopkins urologist Patrick Walsh, M.D.  “With long follow-up, we found no significant difference in the 10-year cancer control rates of these men.”  This is reassuring: “There is no immediate urgency to perform surgery after you are diagnosed with prostate cancer, especially if you have stage T1c disease and a biopsy Gleason score lower than 7.”

Second:  every single statistic about men being cured of prostate cancer you’ve ever seen:  those men all had to wait a few weeks or months, and they did great!  Many of those men got repeat biopsies.  They got second opinions.  They took their sweet time just wrapping their minds around the fact that they had cancer.  They still had their cancer cured.  If you were diagnosed by a change in PSA, here’s more good news:  PSA screening has given us a five- to ten-year lead time in diagnosis.  It used to be that prostate cancer wasn’t diagnosed until it had grown big enough to be felt in an exam, or until it caused symptoms.  You’re already ahead of the game!

Third, the average prostate tumor at diagnosis has been growing for years.  Prostate cancer tends to grow very slowly within the prostate.  It has a slow doubling time.  So, even if it’s an aggressive cancer that needs to be treated, just remember:  that sucker has been in percolating away in there for a long time.  It’s not going to suddenly take off and sprint out of the prostate in the next few weeks.  You are going to get it treated; it’s just not exactly when you planned.

Two more things to consider:  Stress is bad for the prostate.  Worrying about not getting your treatment right away is not good for you.  And finally, you may want to take advantage of this brief delay to lose a few pounds.  The prostate is not terribly accessible in the best of situations, because of its location deep in the pelvis.  If you have a lot of belly fat, it can make it more difficult for a surgeon to perform a good cancer operation, preserve urinary control, and preserve potency.  “The best advice I can give an overweight man seeking radical prostatectomy is to lose weight through a healthy program of diet and exercise,” says Edward Schaeffer, M.D., Ph.D., contributor to our book and director of urology at Northwestern University.  “For those who are severely overweight, robotic surgery is extremely challenging and should be performed only by experienced surgeons.  In men who are very overweight or morbidly obese, it can be very difficult for the anesthesiologist to ventilate the lungs because of the weight of the abdomen pressing on the diaphragm.”  If this applies to you, your best bet – besides having an experienced surgeon – is to take this time to change your diet and get some exercise.

And don’t despair!

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington