Prostate Cancer—To Treat or Not to Treat

Is ‘watchful waiting’ a smart strategy?

Second Opinion Helps Local Man With Prostate Cancer

When John Alden Horn, 67, of Slatington was diagnosed with prostate cancer, he wanted to learn all he could—and he turned to Lehigh Valley Hospital’s Urologic Cancer Second Opinion Service. Horn met with two members of the second opinion team, urologic oncologist Joseph Trapasso,M.D., and radiation oncologist Stephen Perch, M.D.<

"They went over all my options,” Horn says. “Three hours later, I had digested the information and decided on surgery. That one visit diffused my panic and stopped my bewilderment.”

Trapasso performed the surgery a month later, and Horn is feeling great today. “I knew just what to expect,” he says.

Want to Know More about the area’s only Urologic Cancer Second Opinion Service? Call 610-402-CARE.

Prostate cancer usually grows very slowly, making it easier than many cancers to treat before it spreads and becomes life-threatening. In fact, it grows so slowly that some men choose not to seek immediate treatment. Instead, they take a “watchful waiting” approach.

“This doesn’t mean you do nothing,” says urologist John Maggioncalda, M.D., of Lehigh Valley Hospital and Health Network. “You work closely with your doctor to monitor the progression of the cancer. For some, watchful waiting just means delayed treatment.”

Who should choose watchful waiting? Consider this approach if you are age 70 or over; have other serious medical conditions that could shorten your life; or have a low-volume, early-stage tumor with a low PSA (see right). “Every man is different, so it’s important to discuss treatment options with your doctor and even consider a second opinion,” Maggioncalda says.

Some younger, otherwise healthy men choose watchful waiting because they want to avoid surgery or radiation and the potential side effects—incontinence and impotence, says Maggioncalda’s colleague, internist Michael Zager, M.D. “Treatment is a big decision, and sometimes watchful waiting gives men enough time to come to grips with the decision they should make.”

"Understand the risks of watchful waiting," Zager and Maggioncalda say. Prostate cancer can be life-threatening if it grows and spreads outside the prostate. That’s why it’s important that your doctor monitor your progress through:

PSA tests to measure prostate-specific antigen (a cancer marker) in blood. While opinions vary about its effectiveness in detecting cancer, the PSA test is valuable in helping your doctor see how fast cancer is growing.

Digital rectal exams to help your doctor feel changes in a tumor that could signal that it is growing.

Biopsy, the most accurate cancer-tracking tool. Doctors insert a long needle into the prostate and remove samples from different sections to check the stage of the cancer.

Want to Know More about PSA tests or prostate cancer treatment options? See at right.

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