phoenix5 logo This is an archived copy of an original page from The Prostate Cancer InfoLink site that went off-line in February, 2001. It is reproduced at Phoenix5 with the permission of Vox Medica.
More Prostate Cancer Pages at Phoenix5             About this archive

logo for prostate cancer infolink
click here to go to Where To Begin? click here to go to Diagnosis men click here to go to Treatment menu click here to go to Support & Help menu click here to go to Home menu

Why There Are No Easy Answers

Last Revised August 24, 1995

Introduction | Why can't prostate cancer always be cured? | If you've taken out my prostate, how can I still have prostate cancer? | Is it true that some prostate cancers are more dangerous than others? | But I heard about this new treatment on the news... | Is every form of treatment for prostate cancer a gamble?


Most cancers are complicated diseases. Some cancers are even more complicated than others. It may be annoying. It is certainly frustrating. For some, it may even become infuriating. Unfortunately, when it comes to prostate cancer there are very few easy or absolute answers!

In this section, we have tried to discuss why it is that some common questions about prostate cancer just don't have satisfactory answers ... and how patients may want to try and face up to this very difficult realization.

Why can't prostate cancer always be cured?

All too often, we don't know why a particular person gets prostate cancer, when they first got prostate cancer, whether that prostate cancer is actually confined to the prostate or not, whether the most appropriate treatment will in fact work, and even if it does work how long it will work for! Given all those things we probably won't know about a particular patient, perhaps it is amazing that we are actually able to cure as many cases of prostate cancer as we do!

There are two critical problems when it comes to treating prostate cancer. In the first place, prostate cancer is a very slowly growing form of cancer. This means that by the time it is detected and diagnosed, it has probably been developing for years, and therefore has had considerable time to "micrometastacize" -- which means to spread very small groups of prostate cancer cells outside the prostate. These micrometastatic groups of prostate cancer cells may not be detectable at the time that the original site of prostate cancer is found in the prostate itself.

Secondly, although some treatments (including radical surgery, radiation therapy, and cryotherapy) are given with the intent of curing the cancer, none of them in fact can be applied with the certainty that the treatment will in fact work.

If you've taken out my prostate, how can I still have prostate cancer?

Unfortunately, even the most skilled urologic surgeon in the world, using the best surgical facilities and equipment available, and operating on the ideal patient with a small focus of apparently localized prostate cancer in one lobe of the prostate, cannot guarantee to that patient after a radical prostatectomy that he or she has absolutely removed every prostate cancer cell from that patient's body. It need only take one prostate cancer cell to have escaped from that man's prostate into the bloodstream for prostate cancer to reappear in 6 months or a year or more. This is not the news a prostate cancer patient wants to hear, but every patient with an initial diagnosis of prostate cancer is at risk of recurrence of the disease regardless of the stage of his primary cancer or the form of treatment used.

It is now customary practice to use PSA and other tests to "follow" prostate cancer patients after treatment. Ideally, after curative treatment, a patient's PSA level will fall to an undetectable level. New forms of PSA test (the so-called "ultrasensitive" PSA tests) make it even easier to detect whether a patient's PSA has in fact fallen (effectively) to zero. However, as any physician with experience in the treatment of prostate cancer can now tell you, there is always the chance that PSA level will start to rise again.

In the future, we may start to see the RTPCR test used to try to detect whether prostate cancer cells have been left in some patients following curative therapy. However, that will still not make any difference to the actual ability to ensure that the treatment which is tried will in fact work.

Is it true that some prostate cancers are more dangerous than others?

Well, maybe. What we do know is that some prostate cancers grow faster than others, and there are various theories about why this happens. All sorts of tests have been devised in the attempt to help physicians and their patients decide how to act on the basis of such things as "ploidy" (which is a measure of the quantity of DNA per cell nucleus), nuclear "morphometry" (which is a way of measuring differences in shape between the nuclei of prostate cancer cells), and a whole alphabet of new biological markers which have been identified in just the past few years. Some physicians also believe that prostate cancers that appear first in certain parts of the prostate are more likely to behave aggressively than others.

Unfortunately, none of the tests available today can provide definitive information about the likely progression of a particular prostate cancer in a particular patient. All that the doctor is able to do is discuss the available information with you, and then help you to make the best guess about which form of therapy is potentially most appropriate for you.

But I heard about this new treatment on the news ...

And unfortunately you may well have! William Randolph Hearst and others did something utterly amazing. They persuaded millions of people that "the news" and "the facts" are the same thing. They aren't. When you hear the report that begins, "Scientists today reported a major advance toward curing prostate cancer," on the nightly news, you should listen very carefully. In particular, you want to listen for the bit in which someone says, "I don't expect this to be clinically applicable for at least another three or four years." This means that they have absolutely no idea whether it will ever be applicable to any patient, let alone you! The best medical news commentators are very good and careful about how they report advances in medical science. Regrettably, too many journalists are being asked to "report" on advances in medical science with far too little training in either science or medicine.

Because prostate cancer has become the most common cancer diagnosed in male Americans, we can expect to hear many news reports about how to screen for it, diagnose it, and treat it in the next few years. Very few of those reports will be of practical significance to many patients. Your television station, and your radio station, and your newspaper have to find information to fill their "news space" every day. Plenty of organizations and individuals are more than willing to help them fill that "news space" with news. When it comes to listening for information about new forms of prostate cancer treatment, be skeptical. Even if it sounds like a real breakthrough, and the reporter is clearly knowledgeable and well informed, be cautious. Talk to your doctor. Ask him (politely) if he heard the story. Ask him if he has read (or even heard of) the published scientific article on which the story was based. You will gradually discover that many of the "big" advances in any area of science and medicine can be well known to those who specialize in that area of science or medicine long before the "media" gets the story. And, sadly, many of the medical stories that make the nightly news are not actually as important as they may first appear to be.

Is every form of treatment for prostate cancer a gamble?

Bluntly, at the moment, yes. However, just like gambling, there are smart bets and there are dumb bets. Let's say that your brother (who was always a little whacky) dies in a car accident. When they read his will, you discovered that he had left you $100,000 -- with one condition. You have to bet it all on one horse in one horse race in the next year. If you win, you keep everything. If you lose, you lose everything. But so long as there are at least two horses in the race and the race isn't fixed, you can bet on any horse in any race you like.

Now folks, we all know that horse racing comes with some big risks. Huge odds-on favorites have tripped over their own feet while leading by most of the home straight. Rank outsiders which no one has ever heard of suddenly decide that they feel like a good gallop and win races they shouldn't even be in. You know the sort of thing I mean. So what are you going to do?

One way to look it this is to say to yourself, "What the heck, let's try and turn the $100,000 into $1 million by betting on a 10 to 1 shot. If I lose, I can only lose money I didn't have in the beginning anyway!"

Another view is to say, "How do I make as sure as possible that I hang on to the $100,000?" And of course the way to do that is to find a short two-horse race to bet on in which one horse is the winner of the Kentucky Derby ridden by a champion jockey and the other is a 25-year-old plough horse ridden by 12-year-old! You ain't going to win much money. However, your chances of hanging on to the $100,000 look pretty good. But don't say I didn't warn you, funny things can happen in horse races!

If you are diagnosed with prostate cancer, you are going to have to take some risks. You will have to take risks with the form(s) of treatment you choose. You will have to take risks with whom you decide to tell about your disorder. You will have to take risks with which doctor you want to help you through the treatment. Your job is to take those risks with as full an awareness as you wish to have about what you are doing. If you've been cleaning up at the horses for the past 20 years, you may be pretty good at this. If you've lost every penny you ever had to the track, it's time to go and get some really good advice! Remember, one of the most important things you can do is say to yourself, "How will I feel if the odds-on favorite trips over its own feet 20 yards from the finish?" These things do happen.

Where to Begin?    |    Diagnosis    |    Treatment    |    Support    |    Home Page

The content in this section of the Phoenix 5 site was originally developed by CoMed Communications (a Vox Medica company) as part of The Prostate Cancer InfoLink. It is reproduced here with the permission of Vox Medica.

Go to Phoenix5 Main Menu