Summary: Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer: From Diagnosis & Treatment to Managing Advanced Stages of Cancer by Patrick C. Walsh MD and Janet Farrar Worthington

Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer (2001) is a comprehensive and straightforward guide to one of the most common cancers facing men today. Drawing on decades of scientific research and medical expertise, the authors outline every aspect of prostate cancer, including potential causes, testing and diagnosis, current treatment options, and what to expect as a survivor.

Introduction: Take the mystery out of prostate cancer, and face the future with confidence.

Meet the prostate. About the size of a walnut, this unassuming gland sits at the crucial junction of a man’s urinary and reproductive tracts. Functionally, it doesn’t do much – it provides about one-third of seminal fluid, but that doesn’t make it necessary for reproduction. What it can do, however, is cause a world of trouble.

If you’re a man living in America, there is a one in eight chance that at some point in your life, this complicated little gland will develop cancer. While this doesn’t necessarily mean a death sentence – screening and treatment are better than they have ever been – nearly 27,000 Americans will die from prostate cancer this year.

There are a handful of reasons you might find yourself listening to a summary about prostate cancer. Perhaps you would simply like to expand your medical knowledge. Or maybe you are a man looking for ways to reduce the chances of getting this disease. Or maybe you or a loved one has been diagnosed with prostate cancer, and you would like to have a better understanding of what to expect going forward.

Whatever your reasons, these summary will serve as a crash course in the causes of prostate cancer, the treatments available, and what the future holds. While no substitute for professional medical advice, the following summary will hopefully take the fear and mystery out of this potentially devastating disease.

A healthy lifestyle can reduce your risk of developing prostate cancer.

In these days of sensationalism and self-diagnosis, it’s easy to get overwhelmed or unnecessarily scared when hearing about a particular disease or cancer. So let’s start by addressing a simple question: How worried should you be?

Simply put, if you’re from America, or any other Western country, prostate cancer is something to worry about. A boy born in America today has a 12.5% chance of getting it and a 2.6% chance of dying from it. That makes it worth paying attention to.

However, there is a range of factors that can increase your chances of developing prostate cancer – some you can change and some you can’t.

The first and biggest risk factor is age. Prostate cancer takes a long time to develop, so it often doesn’t appear until later in life. In fact, a man over the age of 70 is nearly seven times more likely to develop it than a man aged 50-59.

Another factor is African ancestry. If you are of African descent, you have the highest chance of getting and dying from prostate cancer in the world.

Also out of your control is the fact that prostate cancer runs in the family. This doesn’t always mean it’s hereditary – it’s often the result of a shared lifestyle.

So, what are those lifestyle factors? There are two main things you can control to reduce your chances of getting prostate cancer.

Studies have shown that having too much body fat around your middle not only increases your likelihood of getting it but also reduces the chances of recovery if you do get it.

The second factor is – unsurprisingly – smoking. While this doesn’t directly cause prostate cancer, it does increase the chances of dying from it and reduce the success of treatment.

So in the end, you probably already know how to reduce your risk: Stop smoking, if you haven’t already, and eat smarter. A diet set around a wide variety of vegetables, fruits, grains, low-fat dairy, and proteins is advised.

Early screening is the best thing you can do to increase your chances of survival.

Thinking about prostate cancer isn’t fun. Nobody wants the hassle of going to the doctor and having an uncomfortable rectal exam. But the consequences of not finding it early can be much worse.

The thing about prostate cancer is that, in its early stages, it is silent. No symptoms, no warning signs, nothing. Until it grows outside of the prostate, in which case it is rarely curable.

This is why the best thing to do is get screened and catch it early. If you are in your forties you should talk to your doctor about getting a PSA test – which is just a blood test that checks for prostate cancer – and a rectal examination.

So, what do you do if your PSA level is high, or the doctor feels a lump? First off, you shouldn’t panic. It’s time for a biopsy, to check if it’s cancer. Even if the biopsy comes back positive, you still shouldn’t panic. Prostate cancer comes in many forms and severities.

When you are diagnosed with prostate cancer, there are three things that you will become intimately familiar with as your situation develops. First, as mentioned before, you’ll be keeping a close eye on your PSA level.

Second is your Gleason score. This is a system used to grade the aggressiveness of the cancer.

Finally, you’ll learn the clinical stage of your cancer. This can range from nearly non-existent, to having covered most of the prostate, or – in the most unfortunate cases – spread to the lymph nodes or the bone.

With all this information, it’s now time to start considering your options.

If it is low-risk, consider active surveillance.

You may be asking yourself: “What’s the best treatment for prostate cancer?” Unfortunately, there is no answer to this question. A better question is: “What is the best treatment for me?”

You see, everybody’s experience is different. It’s not just the severity and grade of the tumor that can influence treatment decisions – there are also things like age and general health to consider.

And on top of this is the sufferer’s personal preference. Some men would rather remove an almost-benign tumor than live with the worry, while others find the idea of surgery so stressful that they would prefer a less invasive, but less reliable method. Consider also those on the older end of the spectrum – would an 80-year-old man really benefit from an aggressive treatment with side effects and recovery time?

Let’s look at a specific scenario: The doctors have confirmed that you do have cancer, but it is low-risk, not very aggressive, and not very large. A common option in this situation is simply to closely monitor the tumor with the intention of initiating treatment if anything changes.

Ronald Reagan once said: “Trust, but verify.” This slogan sums up this approach often used to deal with less severe forms of prostate cancer: Active surveillance.

It may seem counterintuitive to not immediately remove or treat the cancer, but this is where the “trust” part of Reagan’s quote comes in. You need to trust the evidence-based medical opinion that the cancer is indolent – meaning that it’s not doing much, and may never have to be treated.

Though don’t forget the other part – “verify.” Cancer is unpredictable, so you will still be having regular check-ups and testing.

With a bit of luck, the cancer will stay the same, and you will live a long and happy life. But what do you do if it becomes more severe? Or if it was in a later stage from the start?

It’s time for action.

Radical prostatectomy is the gold standard in prostate cancer treatment.

Picture, if you will, the many-headed hydra from Greek mythology. You battle this fearsome beast, cutting off its heads, only to have more grow back in their place. This is not too different from prostate cancer – on average, three to seven tumors will be growing in the prostate at once. So, instead of chopping off the heads, why not target the whole thing?

Radical prostatectomy is the most effective cure if the cancer is confined to the prostate. It’s considered the gold standard in treatment, and if done by an experienced surgeon, negative side effects like impotence and incontinence can be rare.

So, who is this for? The top candidates for radical prostatectomy are otherwise healthy men who are expected to live for another 15 years or more, and whose cancer is deemed curable. If someone is expected to die from other old-age-related diseases before a cure is necessary, the surgery may not be worth it.

These days, this kind of surgery is not something to be scared of. Recent changes in technology and approach ensure that minimal damage is done to the surrounding area, and urinary control and sexual function are minimally affected.

It’s also possible to perform the surgery using a laparoscopic procedure. Don’t let the fancy word confuse you, it just means that the surgery is done through small holes, with the guidance of a fiber-optic camera.

Laparoscopy can be made more precise through the robotic-assisted approach. This involves a 3-D sensing camera, and an externally controlled, extremely precise surgical system. But it’s important to remember that even with this method, there is still a dedicated and skilled surgeon controlling every moment of the operation.

And it does come down to the skill of the surgeon. If they have the training and know the anatomy, a radical prostatectomy is a great option for younger, healthy men.

Radiation and cryo or thermal ablation are less-invasive alternatives to surgery.

For some men, surgery can be much too invasive, and the associated risks and recovery time are not worth the trouble. Luckily, several less-invasive treatments are considered nearly as effective.

One such option is radiation therapy. This basically involves shooting radiation at the prostate, causing the targeted cells to die. The right amount of radiation must be used so the cancer is killed, but not the surrounding healthy tissue. Luckily the method has been finetuned over the years, and it is now extremely accurate and precise. The patient wears a custom-made body suit so they remain completely still, and the same position can be reproduced for each dose of radiation.

A variation of this is brachytherapy, which involves inserting radioactive seeds into the body, to gradually attack the cancer over time.

However, radiation therapy is not without its complications. After three to five weeks of treatment, many men may experience fatigue and need to go to the bathroom more. There are also long-term effects – damage to the small blood vessels can make it difficult to get an erection over time.

Another non-invasive option is cryo or thermal ablation, which involves heating or freezing the prostate. This method is a bit newer, and there are fewer long-term studies comparing it to surgery and radiation therapy. Advocates for this option point out that it is an easier experience, with fewer side effects. However, there is a greater risk of missing the cancer, so the other options are often preferred. A doctor might recommend cryo or thermal ablation if the patient has a larger and more serious tumor, or if the cancer has returned after radiation therapy.

Once again, the best option for you is specific to your unique situation. However, take comfort in knowing that these less-invasive methods exist, and in the right situations can be as effective as surgery.

Hormone therapy is useful in extreme cases, but shouldn’t be the primary treatment.

There is one remaining avenue to explore when looking at treatment options: Hormone therapy.

The treatments you’ve seen up until now are most effective for treating lower-grade, localized prostate cancer, which is still contained to the prostate. Because hormone therapy does not actually cure the cancer, it should not be used as the primary treatment in these situations. However, hormone therapy becomes essential when the disease is metastatic, meaning it has spread to other parts of the body.

So, how exactly does it work? Hormone therapy shuts down the hormones that feed the prostate, and consequently, the cancer. The most effective way to do this is to surgically remove the testicles, which is obviously not a desirable choice for many men. Luckily, the effect can also be achieved medically with the appropriate drugs.

The thing with hormone therapy is that it doesn’t stop the clock. If the cancer has spread to the bone, or it’s so large that it’s blocking the kidneys or bladder, then it is the perfect choice and should be started immediately – the cancer will quickly shrink and the patient will feel better.

However, if things aren’t that bad, there is no evidence that starting hormone therapy early will increase a patient’s life expectancy. Despite initially shrinking, the cancer will continue to grow over time and additional treatments may still be needed.

And the side effects may not be worth it in the long run. Because it is essentially restricting the male hormone, the results can be loss of sexual desire, reduced muscle mass, and thinning of the bones, just to name a few. It can dramatically change how a man acts and feels, so it should not be chosen lightly.

As always, consult your doctor, and be aware of the consequences of this somewhat extreme option.

Don’t be frightened of the future.

You’ve consulted your doctor, chosen the right treatment for your unique situation, and undergone whatever procedure was deemed best. You may be asking yourself: Will my cancer be cured forever?

For prostate cancer to be cured, two things must be true. Firstly, the cancer needs to be diagnosed at a stage where it is curable – meaning it hasn’t established itself outside of the prostate. Secondly, the treatment has to work. If these conditions are met, a complete cure is possible.

However, unless the prostate has been completely removed, there is always the possibility that cancer can spring up again, by the same factors that caused it to appear in the first place.

After treatment, it is important to keep having your PSA checked regularly. Studies show that if your PSA level is undetectable 10 years after surgery, then you are unlikely to die of prostate cancer.

What about living with the side effects of treatment? One of the most troubling problems for men after surgery or radiation therapy is erectile dysfunction. Unless the treatment involved hormone therapy, this is a purely mechanical problem. The good news is that erectile dysfunction can be treated, and most men can recover sexual function.

And there is always hope. Even in patients who are unresponsive to hormone therapy, prostate cancer treatment and research are constantly advancing. New drugs and agents are being clinically tested and made available all the time, and the future is nothing but hopeful in the ever-changing world of prostate cancer.

So no matter your journey, the most important thing is to face the future with optimism and courage. You are not alone, and there’s never a reason to give up.

Summary

The story of prostate cancer is constantly changing and being retold. Only a few decades ago your options would have been limited and extremely brutal. Now we know enough to be able to confidently monitor a confirmed cancer using active surveillance if it isn’t an immediate threat.

And more aggressive treatments such as radical prostatectomy and radiation therapy are tested and reliable enough to let us face the disease head-on. Even the less preferable option of hormone therapy offers promising results in the later stages of cancer.

While risks can be minimized with a healthy lifestyle, it’s important to remember that when the cancer is still curable, it is silent. The most important thing that any man can do is simply get checked.

Go ahead and call your doctor today – it just might save your life.

Review

“Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer” is a comprehensive guidebook that offers a well-rounded understanding of prostate cancer, its diagnosis, treatment options, and survival strategies. Co-authored by Dr. Patrick C. Walsh, a renowned urologist, and Janet Farrar Worthington, a veteran health writer, this book is an invaluable resource for anyone affected by prostate cancer. In this review, we’ll delve into the book’s key aspects, strengths, and weaknesses.

The book is divided into three parts:

• Part One: Understanding Prostate Cancer discusses the anatomy of the prostate gland, the different types of prostate cancer, and the signs and symptoms of the disease.
• Part Two: Treating Prostate Cancer provides detailed information on the different treatment options for prostate cancer, including surgery, radiation therapy, and hormone therapy.
• Part Three: Living with Prostate Cancer discusses the emotional and psychological impact of prostate cancer, and offers advice on how to cope with the disease.

Key Aspects:

• Informative and Accessible: The book explains complex medical concepts in an accessible and easy-to-understand manner, making it a great resource for patients and their families who may not have a medical background.
• Holistic Approach: “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer” takes a holistic approach to cancer care, discussing various treatment options, including surgery, radiation therapy, hormone therapy, and alternative therapies. It also emphasizes the importance of lifestyle changes, such as diet and exercise, in cancer treatment and survival.
• Patient Stories: The book includes inspiring stories from prostate cancer patients, providing a sense of hope and community for those going through a similar journey.
• Up-to-Date Information: The authors ensure that the information is current and relevant, discussing the latest research, treatments, and technologies in the field of prostate cancer.
• Practical Tips: The book offers practical advice on various aspects of prostate cancer care, such as how to prepare for doctor’s appointments, understanding medical jargon, and managing treatment side effects.

Strengths:

• Authority: Dr. Patrick Walsh is a renowned expert in the field of urology and prostate cancer treatment, lending credibility and authority to the book’s content.
• Comprehensive: The book covers a wide range of topics related to prostate cancer, leaving readers feeling informed and empowered.
• Accessible: The authors’ use of clear, concise language makes the book accessible to a broad audience, including those without a medical background.
• Holistic Approach: The emphasis on lifestyle changes and alternative therapies provides a well-rounded perspective on cancer treatment and survival.
• Relevant: The book’s focus on current research, treatments, and technologies ensures that readers receive up-to-date information that can be applied to their care.

Weaknesses:

• Lack of Personalized Advice: While the book offers valuable information, it may not provide personalized advice that patients may need for their unique situations.
• Medical Jargon: Although the authors aim to explain complex medical concepts in simple terms, some readers may still find certain sections challenging to understand due to technical language.
• Length: The book’s comprehensive nature results in a lengthy read, which can be overwhelming for some readers.

Here are some additional thoughts on the book:

• I appreciate that Walsh is very clear and concise in his explanations of the different aspects of prostate cancer.
• I also appreciate that Walsh provides real-world examples of men who have successfully battled prostate cancer. This gives readers hope and inspiration.
• Overall, I thought Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer was an excellent book. It is a must-read for any man who has been diagnosed with prostate cancer.

Conclusion:

“Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer” is an invaluable resource for anyone affected by prostate cancer. The book’s comprehensive approach, authoritative voice, and practical tips make it a must-read for patients, caregivers, and healthcare professionals. While it may have some limitations, such as a lack of personalized advice and occasional technical language, the book’s strengths far outweigh its weaknesses. This book empowers readers with the knowledge and tools necessary to navigate the complex journey of prostate cancer with confidence and hope.

Rating: 4.5/5

Recommendation:

I highly recommend “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer” to anyone recently diagnosed with prostate cancer, undergoing treatment, or looking to gain a better understanding of the disease. This book is also a valuable resource for caregivers, family members, and healthcare professionals seeking to provide support and guidance to those affected by prostate cancer.