Alcoholic Actuary
Veteran Member
A man is diagnosed with early stage prostate cancer at a relatively young age. Because the cancer is at the early stages, he is given the following treatment options:
1. Active surveillance/watchful waiting. He is carefully monitored throughout his life to determine if his cancer progresses enough to warrant a more aggressive treatment. Urinary continence and sexual function are preserved. He is still fertile. His cancer may progress and such progression may not be noted until it has advanced, leaving him with more grim treatment options than those mentioned in this post.
2. Surgery. There are several different options for surgery but he is relatively young and healthy and his surgeon is very well experienced with extremely good track record for definitive cure of the cancer while preserving continence and sexual function. He will still need to be monitored in case of recurrence. He will no longer be fertile. If he thinks that he might wish to procreate in the future, he should arrange to freeze sperm for such prior to the surgery. There will be some urinary incontinence and no sexual function short term--for a week or a few and he will have some restrictions on physical activities until he is well recovered from surgery--a few months. Sexual potency will almost certainly return as will urinary continence.
3.Radiation: a. Brachytherapy. Small, radioactive rods are implanted that will direct low level radiation at the prostate and kill the cancer cells. The rods will remain in place throughout the man's lifetime. Pregnancy should be avoided and he should wear a condom to protect his partner(s) from any possible exposure to radiation from his semen. Potency and urinary continence will be preserved but will likely decline over years at a more rapid rate than a man without such issues would likely experience as general damage from radiation accumulates. There is some risk of damage to the bladder and of developing a fistula between bladder and rectum.
b: Proton Beam therapy: Much more expensive with limited centers offering this treatment at this time. In theory, this type of radiation spares nearby normal tissue, resulting in less tissue damage. It is relatively new so long term effects which might develop over years or decades (relevant as this is a young patient) are not well documented. It could be assumed that similar potential issues with developing incontinence and impotence may occur.
I am purposely not mentioning other therapies because they are used for more advanced or recurrent prostate cancer. This patient is a relatively young, healthy man with early stage prostate cancer.
He is also married. Prior to his diagnosis, he and his wife were considering having a child.
Whatever treatment option is chosen, his wife will be affected, perhaps profoundly. Short term, he will need some care regardless of treatment chosen and depending on option, she will at least temporarily need to assume any tasks that involve lifting or physical exertion. Her ability to have a child with her husband will be affected. Their sex life will be affected at least short term and perhaps long term. Potentially, permanently.
How much say should the wife get in the man's decision about treatment options?
And, would you consider the prostate cancer as some sort of jointly held property?
aa