How often have I said that when you are diagnosed with metastatic prostate cancer or when you experience a recurrence you need to move on to a specialist, a medical oncologist who specializes in the treatment of men with advanced prostate cancer? It is easier and more comfortable to stay with the known doctor, the trusty urologist who has so far guided you through the disease process to date. However, this comfortable decision will not maximize your survival potential!
The treatment of advanced prostate cancer has become more complex and it promises to become even more so in the near future. In just four years we have had FDA approval of six new treatments and we are very possibly going to look at least two more within the next year.
Treatment options are increasing and when you factor in the growing possibilities of combinations of these new treatments into “cocktails” you can see the increasing complexity involved in optimal treatment. Then when you add to the mix our ever-increasing understanding of the complexities of the disease itself because of genetic differences in each man’s prostate cancer you begin to understand how important having the right doctor has become in order to maximize your survival.
This reality even extends down to what treating institution your doctors are associated. A recent study of older patients with advanced head and neck cancers has found that where they were treated significantly influenced their survival (Cancer (2013; doi:10.1002/cncr.27976).
The study found that when patients were treated at hospitals that saw a high number of head and neck cancers the patients were 15% less likely to die of their disease as compared to patients who were treated at hospitals that saw a relatively low number of such cancers. On top of this number they also found that such patients were 12% less likely to die of their disease when treated at a National Cancer Institute-designated cancer center.
Patients with advanced cancers require multidisciplinary management by a collaborative team comprised of multiple physician specialties and disciplines. National Comprehensive Cancer Network (NCCN) guidelines, based on data from randomized controlled trials, recommend multimodality therapy.
Each of us, no matter the cancer we are fighting, need to maximize our chances of survival by making decisions on who provides our treatment and where we find our treatment. For those of us men who are fighting advanced prostate cancer, deciding to go to a major hospital with experience in treating advanced prostate cancer and to medical oncologists who specialize in treating men with advanced, metastatic prostate cancer will improve our survival potential.
So, those of us who remain with our trusted family physician or urologist need to make this decision with the clear understanding that we do so with the possible peril of not surviving as long as we might otherwise.
Joel T. Nowak, M.A., M.S.W.