Friday, May 25, 2007

It is the patients decision!

I would like to discuss this disease as it gets into the advanced stage. This is a patient diagnosed with metastatic cancer or high Gleason, PSA, Stage that might indicate metastatic cancer - or at least possible micro-mets. Or a person who has failed his initial treatment and has a rising PSA. In both of these cases the prognosis is not good.

The question arises in both of these cases as to whether the treatments for this stage will lengthen the life of the patient and at what physical or mental costs. We have conflicting data on this but we believe that at least Hormonal Ablation Therapy (HT) will extend one's life but we have no long term studies comparing patients using or not using HT. But enough that has convinced us that this is the first treatment of choice in advanced disease.

We have to assume at some point in time the advanced patient will become refractory to HT and move on to secondary Hormonal Ablation Therapy and on to Chemotherapy. In this case, unless something else kills the patient first, prostate cancer will take the life of this patient at some time. For example we have few studies that show that any chemotherapy has an effect on the extension of life for anything other than a few months. Often times we go on a treatment protocol that keeps our PSA down for a few months and we look at that as an extension of our life - but is it really? Or is it just a few months that we might have had anyway. I don't think we know.

So now we have a question that only the patient should answer - not the wife, not the girl friend, not the doctor, not a friend - only the patient. That question would be how long do I want to stay alive and at what cost to my quality of life - is quality more important than quantity. When that answer has been made by the patient after deep thought and with full truthful knowledge as to where he is in terms of the disease - it is a killer disease. Whatever the answer is at that time may be changed later - the patient should not be pressured into sticking to that first decision. It is his body, mind and soul that we are talking about - no one else.

If we try to influence the patient by telling him everything is OK and we will fight it through until we find a cure. Are we doing a disservice to the patient when we know deep down and know that all the studies say that the disease is going to kill hum. Are we doing a disservice to that patient by talking him into Chemotherapy which the treatment may be worse than the disease at times. Are we doing a disservice to the patient telling him that diet and supplements are going to cure him or even help him. Are we doing a disservice to a patient to force him all over the country or even the world trying to find a cure when there is none.

I personally feel that a lot of the time that is exactly what we are doing. We must face reality - good or bad we must face it, live it, accept it and tell it like it is!

What do I feel we should do? Face the facts! Face the inevitable death from this disease in those high risk patients. And live for the moment.

I believe once a patient can honestly say to himself that this disease is going to kill me in time and this fact is accepted by those loved ones around him - a whole new life opens up for him and those loved ones. A new life and happiness that he may have never experienced before, a happiness and satisfaction with his self that sets in to bring many joyful things to him in those remaining years. A true happiness that many me who fight this disease every day of their life never reaches or even understands.

Away with the diet, away with the supplements, away with anything else that does not bring enjoyment to the patient. If none of these help, and we have evidence that they do not at this stage, why burden the patient with a bunch of nonsense and give him false hope. Additional treatment that might be worse than no treatment and with no proof they will extend his life - its his decision and his alone. Let the patient say - no more treatments - I want to enjoy the rest of my days to the fullest. Let the patient do things he always wanted to do but never had a chance. Fishing in Alaska - go for it. Cruise in the Caribbean - take it. Learn to sky dive - get the excitement. Give him the chance along with his loved one to enjoy every minute of his life to the fullest extent possible. Don't say you can't do something - he knows himself and he can make those decisions.

Stop pressing him and let him do what he wants to do to enjoy his remaining years. In the long run the family and loved ones will find they are all ahead in doing so.

Then when the time comes that the family can no longer care for him - get the help of Hospice. If he has gone through the above he will welcome the Hospice for himself and for those that will be helped in the care of him. And when the time comes all gather together in remembrance of all of the happy times together and give his permission to pass so he does so without anguish and regret.

At least this is the way I see it and I believe that this is the best thing we can do for the patient - make his remaining days happy days!