Most helpful critical review
5 of 7 people found the following review helpful
Written by a surgeon, biased for surgery
on August 1, 2011
This appears to be a book that nearly all urologists recommend to their patients who have just been told that they have prostate cancer. Mine sure did. That's not surprising because, like Dr. Walsh, urologists are all surgeons, and Dr. Walsh's book is heavily biased toward surgery. Unfortunately, the first contact all of us have with this disease is through a urologist/surgeon. And, once patients take the primrose path of surgery, urologists remain the treatment specialist well past the time when the plumbing has been removed.
This simply isn't right. With most other kinds of cancer, medical oncologists play the central role. They are experts in the various treatments options and can choose what is best for patients based on their circumstances. They aren't surgeons or radiation oncologists, so they don't have a bias toward any treatment. There are prostate cancer books written by medical oncologists that provide a more balance view, such as those by Dr. Strum, Dr. Myers or Dr. Scholz. I'm hoping a new book will come out that's even better, providing comprehensive coverage of the disease and options from the medical oncologist's perspective.
That's not to say that this book isn't a good reference work. If you always keep in mind that you are being prodded to decide in favor of surgery, much of the information provided on diagnosis, disease characteristics, anatomy and such are quite valuable. Even the information about surgery contains information that is hard to find elsewhere. Yet, because of its biases and because it is now out-of-date, you cannot rely solely on this book to make a decision.
Surgery can have major consequences, even in the best hands. Unfortunately, it is unlikely your local surgeon will be as skilled as someone like Dr. Walsh, and so you can't expect the same results as the top doctors advertise. And even these results are not all that stellar. Staging of prostate cancer is still a black art. There are no tests the let the doctor know exactly what they will find when they open you up. They rely on rectal exams, your PSA level, biopsy results, and some statistical models to guess at what stage of your cancer is at. Very often the biopsy is incorrect (very important to get a second opinion from an expert in prostate cancer), which begins the process on the wrong foot. And staging is frequently misjudged, with more serious conditions being found after surgery.
As a result, a percentage of patients who have now suffered through surgery are discovered to have conditions that require them to be subjected to radiation therapy. Some are even because the surgeon was not skilled enough and left some cancer behind. It is then you realize that perhaps you should have just chosen radiation therapy to begin with, given that it has at least as good a rate of cure as surgery and arguably not as severe side effects. You are then left with a shorter member, dry orgasms, possible incontinence, and definite reduction in erectile functioning, with more hardship on the way. Or maybe some other option such as active surveillance would have been a better first choice.
As you can see, choosing the right treatment for prostate cancer can be a minefield. It is not helped by the fact that your first-line physician has a strong bias in favor of a procedure that makes his lake house payments. You owe it to yourself to go beyond the this book and find the best advice you can. Prostate cancer is slow growing, and even Dr. Walsh admits that you have the time, weeks and even months, to learn everything you can and make the best decision for you. As he says, this is the most important part of the entire process and is worth the effort. See -- he does have some great advice!