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Best option for prostate cancer treatment is individual choice

Allen Lash began with a belief that surgery was his last choice to cure prostate cancer.

"When you're diagnosed with prostate cancer, you're dealing with two main issues," he says. "First, your own survival. Second, quality-of-life issues, such as incontinence and sexual function. Because of what I thought I knew about surgery, I didn't want it."

But after talking with specialists in urology, oncology, and radiotherapy, and reading extensively, Lash learned that nerve-sparing surgery has greatly reduced impotence and incontinence.

"When I asked specialists about other options, they'd say, 'We're as good as surgery,'" he says. "To me, it meant surgery was the gold standard."

He began researching surgeons. "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer emphasizes that your choice of surgeon is crucial," he says. "I didn't want someone who has done only 100 surgeries. I looked for someone who had done more than 1,000."

Lash's wife, Yvonne, compiled a list of recommended surgeons. "Walsh suggests questions to ask," Lash says. "How many surgeries has the surgeon done? What are the results? What percent of patients are physically continent after a year? What percent have erectile function? What's the survival rate?"

His research led him to Michael Blute, chair of the Department of Urology at the Mayo Clinic in Rochester, Minnesota. "He does three to 10 surgeries per week," Lash says.

"When I sat down with him, he said quality of life may be less than other methods for a few months after surgery," Lash says. "With other options, quality of life may be better up front, but it diminishes with age. I'd rather have quality of life issues at 62, knowing things will improve than go through it at 72, with less hope for recovery."

Blute says men under 65 with early prostate cancer and in good health typically have more treatment options.

"We're seeing a stage shift in prostate cancer," he says. "Prior to PSA (prostate-specific antigen) tests, we saw more advanced cancer, spread beyond the prostate. Today, we see younger patients -- the average age is 58 to 60 -- with organ-confined cancer. That has a major impact on survival. We're also using PSAs in a smarter way. We know now rate of change may be more crucial than a single reading."

Allen Lash began with a belief that surgery was his last choice to cure prostate cancer.

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