Busy Executive Faces an Important Decision
Introduction
Seattle resident Fred, at age 55, had a full and active life in the Spring of 2012. Fifteen years into a career with a small Seattle software company, he had risen to President, and held an equity stake in the company. The company provides Business Intelligence tools to manufacturers and distributors across North America. These software tools help provide critical information to management so they can make informed decisions. Little did he know that he was about to be faced with one of the biggest decisions of his life.
Diagnosis
Fred’s doctor had been monitoring his PSA level, which had been rising slowly over the course of several years. When the test revealed an unusually high reading of 4.1 the doctor decided it was time for a closer look. On a Tuesday afternoon in April 2012, a Seattle urologist performed a routine, 12-core prostate biopsy.
The life-changing call came the next day: “Fred, the biopsy shows you have prostate cancer. It is present in all 12 of the samples, some as much as 100%, and there is no indication that it is contained to the prostate. Let’s meet on Friday to discuss your options. Bring your family.”
Search
Having a career that specializes in helping people make decisions, the next step was obvious; get the information necessary to consider the treatment options, and choose the best one for his particular diagnosis. Fred began a thorough, deliberate process of reviewing the available treatment options, with an emphasis on side-effects. Over the course of the next few months he would spend hundreds of hours researching and reading, and see over a dozen doctors. Most of these conversations focused on the process and the potential side-effects of the recommended treatment option. The result was a dizzying multi-dimensional array of things to consider. Which was preferable, a 30% chance of incontinence, or a 25% chance of impotence? Or some combination of the two? Would you prefer surgery, where the impact is instantaneous and the recovery is gradual, or radiation, where the impact is delayed and the results may not be known for some time?
One pattern began to emerge as the process moved forward; medical providers recommend the treatment that they offer. Surgeons recommend surgery. Radiation oncologists recommend radiation. It became apparent that the medical community had assets, equipment and facilities that they needed to keep busy, and they were all motivated to bring in new patients.
An appointment with the family physician, helped bring it all into focus. After hearing all of the confusion and anxiety, he asked “Well, what is the most important thing?”. After Fred launched into a description of the treatment options and side effects the doctor interrupted and simply said “Don’t forget, Fred, the most important thing is this: you want to live”. Suddenly it was clear what had been missing. Efficacy, in terms of cancer control trumped every other consideration. And yet, Fred had found virtually no information about the relative recurrence and survival rates for each of the treatments.
The research results from the Prostate Cancer Treatment Center Foundation provided just the information he had been missing.
The Prostate Cancer Treatment Center Foundation was formed to help prostate cancer patients by improving treatment through education and research. Interestingly, there has never been a randomized study of prostate cancer treatment outcomes, and patients are painfully challenged to get reliable, unbiased information about treatment results. The Foundation supports The Prostate Cancer Results Study Group (PCRSG) in its efforts to evaluate the comparative effectiveness of prostate cancer treatments using current modern literature results as a basis. The ongoing task of the group is to find comparable studies and present these studies and outcomes in an easily-understandable form to all interested groups. The Foundation goal is simple: get the best information to every patient with prostate cancer.
Decision
After a thorough review of the treatment options, and the research results, Fred chose a duo-therapy; radioactive seed implant (brachytherapy) combined with a 5-week regimen of external beam radiation (EBRT).
Outcome
Fred finished treatment in October of 2012. Prior to treatment, his PSA level was 4.1 and rising. When tested in November, it was 0.27, and has been falling steadily since then. His symptoms and side-effects have been manageable, and he is getting back to a normal routine.
Fred says, “My cancer diagnosis was a life-changing event. I have a new appreciation for this wonderful life, for the people around me, and for the simple pleasures that are everywhere, if we just take a moment to appreciate them. A prostate-cancer diagnosis is not a death sentence. Good physicians, and access to the right information can lead to a good outcome. I’m very grateful for the on-going work of the Prostate Cancer Treatment Center Foundation”.
(Return to Prostate Cancer Treatment Center Foundation webpage)