WHAT KILLS MEN WITH ADVANCED PROSTATE CANCER

Ultimately, what kills men with advanced prostate cancer are these malignant hormone-insensitive, or androgen-insensitive, cells. And right now, we don’t have any way to stop them. Standard chemotherapy—a host of drugs that work so well in treating other kinds of cancer—doesn’t help, mainly because it’s designed to target cells that are dividing much faster than those in prostate cancer. (Newer chemotherapeutic drugs that target growth factors may produce better results.)

Which leaves us, finally, with palliative treatment—easing symptoms and pain, and keeping up nutrition in men who don’t feel like eating. In this stage of treatment, thankfully, there is much that can be done, and you have a right to demand everything possible—medication or a procedure to ease pain or symptoms of urinary obstruction—to make the situation better.

One reason for these differences of opinion is that doctors treating men with end-stage cancer are desperate. Most of them—the best of them—care deeply about their patients, and are willing to try every last-ditch measure they can think of to help them. Say a study trumpets the benefits of the latest drug—one drug, for example, created a stir in the medical community because it was said (with debatable accuracy) to prolong life for several months. Many caring physicians will go ahead and prescribe such a medication, even though, deep down, they realize it probably won’t help. They figure that there’s a race against time, and they’re losing it. And that any effort is better than none.

Ultimately, what you decide to do, what drugs and treatments you decide to try, is up to you—as it should be. Read this material, plus any other information you can get your hands on (for some suggestions on where else to look for answers, see page 289). Talk to your doctor, and get a second opinion; talk to your family, to any other prostate cancer patients you can find, and make the best, most informed decisions you can.

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