Dr. Patrick Walsh's Guide to Surviving Prostate Cancer

by Patrick C. Walsh, Janet Farrar Worthington

A leading urologist presetns an authoritative guide to prostate cancer survival that covers every aspect of the ailment, from its potential causes and diagnostic tests to treatment, prevention, and dealing with such sensitive side effects as impotence and incontinence. 50,000 first printing.

Genres: Health, Medicine, Nonfiction

488 pages, Hardcover

First published August 28, 2001

About the author

Librarian Note: There is more than one author in the Goodreads database with this name.

Reviews

[Rick Redner · Rating 5 out of 5]

Every man who is diagnosed with prostate cancer, (I'm one of those men) are faced with one of the most difficult decisions of their lifetime. They must choose how to treat their cancer. I read dozens of books before I chose surgery and this book was by far the most useful.

The size of the book and extent of information can be overwhelming. However each chapter starts with chapter summary. This enables you can decide whether or not this is chapter you'll need to read.

I recommend this book to any man diagnosed with prostate cancer.

[Chuck · Rating 5 out of 5]

There are only two reasons to read a book like this. Either you have a raging desire to gain as much medical knowledge as you can, or you have been diagnosed with prostate cancer. I have been diagnosed with prostate cancer. When you go to some doctors they give you a little bit of information but not enough., you have to find information yourself. My wife found this book and we both started reading it. Dr Walsh has put together an amazing book on Prostate cancer, the causes, the cancer, and the cures. This book does not read like a medical journal, it reads like an interesting story of a cancer that was uncontrollable and is now one of the most cured cancers in the world. Citing worldwide studies, successes from other doctors and his breakthrough discoveries at Johns Hopkins, Dr Walsh give you all of the treatment options for all stages of the disease and helps you through the uncertain times that are ahead. If you have a loved one that has prostate cancer or you have it yourself, this book is a must read to get you through the coming trials. One last note, I was lucky enough to find a doctor within 2 hours from my house that studied under Dr Walsh at Johns Hopkins. I know that I am in the best hands that I could be in with my cancer.

[Brian Lyke · Rating 3 out of 5]

This book is getting quite dated, many new therapies and not much information for Advanced Stage cases. Top Dr and good info, will definitely read new release when it comes out later this year.

[Steve · Rating 5 out of 5]

Provided excellent information with outstanding layman's definitions of medical terminology. Helped me immensely in choosing the best course of action for my life.

[Jung]

Take the mystery out of prostate cancer, and face the future with confidence.

Meet the prostate. About the size of a walnut, this unassuming gland sits at the crucial junction of a man’s urinary and reproductive tracts. Functionally, it doesn’t do much – it provides about one-third of seminal fluid, but that doesn’t make it necessary for reproduction. What it can do, however, is cause a world of trouble.

If you’re a man living in America, there is a one in eight chance that at some point in your life, this complicated little gland will develop cancer. While this doesn’t necessarily mean a death sentence – screening and treatment are better than they have ever been – nearly 27,000 Americans will die from prostate cancer this year.

There are a handful of reasons you might find yourself reading a book about prostate cancer. Perhaps you would simply like to expand your medical knowledge. Or maybe you are a man looking for ways to reduce the chances of getting this disease. Or maybe you or a loved one has been diagnosed with prostate cancer, and you would like to have a better understanding of what to expect going forward.

Whatever your reasons, this book will serve as a crash course in the causes of prostate cancer, the treatments available, and what the future holds. While no substitute for professional medical advice, the following book will hopefully take the fear and mystery out of this potentially devastating disease.

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A healthy lifestyle can reduce your risk of developing prostate cancer.

In these days of sensationalism and self-diagnosis, it’s easy to get overwhelmed or unnecessarily scared when hearing about a particular disease or cancer. So let’s start by addressing a simple question: How worried should you be?

Simply put, if you’re from America, or any other Western country, prostate cancer is something to worry about. A boy born in America today has a 12.5% chance of getting it and a 2.6% chance of dying from it. That makes it worth paying attention to.

However, there is a range of factors that can increase your chances of developing prostate cancer – some you can change and some you can’t.

The first and biggest risk factor is age. Prostate cancer takes a long time to develop, so it often doesn’t appear until later in life. In fact, a man over the age of 70 is nearly seven times more likely to develop it than a man aged 50-59.

Another factor is African ancestry. If you are of African descent, you have the highest chance of getting and dying from prostate cancer in the world.

Also out of your control is the fact that prostate cancer runs in the family. This doesn’t always mean it’s hereditary – it’s often the result of a shared lifestyle.

So, what are those lifestyle factors? There are two main things you can control to reduce your chances of getting prostate cancer.

Studies have shown that having too much body fat around your middle not only increases your likelihood of getting it but also reduces the chances of recovery if you do get it.

The second factor is – unsurprisingly – smoking. While this doesn’t directly cause prostate cancer, it does increase the chances of dying from it and reduce the success of treatment.

So in the end, you probably already know how to reduce your risk: Stop smoking, if you haven’t already, and eat smarter. A diet set around a wide variety of vegetables, fruits, grains, low-fat dairy, and proteins is advised.

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Early screening is the best thing you can do to increase your chances of survival.

Thinking about prostate cancer isn’t fun. Nobody wants the hassle of going to the doctor and having an uncomfortable rectal exam. But the consequences of not finding it early can be much worse.

The thing about prostate cancer is that, in its early stages, it is silent. No symptoms, no warning signs, nothing. Until it grows outside of the prostate, in which case it is rarely curable.

This is why the best thing to do is get screened and catch it early. If you are in your forties you should talk to your doctor about getting a PSA test – which is just a blood test that checks for prostate cancer – and a rectal examination.

So, what do you do if your PSA level is high, or the doctor feels a lump? First off, you shouldn’t panic. It’s time for a biopsy, to check if it’s cancer. Even if the biopsy comes back positive, you still shouldn’t panic. Prostate cancer comes in many forms and severities.

When you are diagnosed with prostate cancer, there are three things that you will become intimately familiar with as your situation develops. First, as mentioned before, you’ll be keeping a close eye on your PSA level.

Second is your Gleason score. This is a system used to grade the aggressiveness of the cancer.

Finally, you’ll learn the clinical stage of your cancer. This can range from nearly non-existent, to having covered most of the prostate, or – in the most unfortunate cases – spread to the lymph nodes or the bone.

With all this information, it’s now time to start considering your options.

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If it is low-risk, consider active surveillance.

You may be asking yourself: “What’s the best treatment for prostate cancer?” Unfortunately, there is no answer to this question. A better question is: “What is the best treatment for me?”

You see, everybody’s experience is different. It’s not just the severity and grade of the tumor that can influence treatment decisions – there are also things like age and general health to consider.

And on top of this is the sufferer’s personal preference. Some men would rather remove an almost-benign tumor than live with the worry, while others find the idea of surgery so stressful that they would prefer a less invasive, but less reliable method. Consider also those on the older end of the spectrum – would an 80-year-old man really benefit from an aggressive treatment with side effects and recovery time?

Let’s look at a specific scenario: The doctors have confirmed that you do have cancer, but it is low-risk, not very aggressive, and not very large. A common option in this situation is simply to closely monitor the tumor with the intention of initiating treatment if anything changes.

Ronald Reagan once said: “Trust, but verify.” This slogan sums up this approach often used to deal with less severe forms of prostate cancer: Active surveillance.

It may seem counterintuitive to not immediately remove or treat the cancer, but this is where the “trust” part of Reagan’s quote comes in. You need to trust the evidence-based medical opinion that the cancer is indolent – meaning that it’s not doing much, and may never have to be treated.

Though don’t forget the other part – “verify.” Cancer is unpredictable, so you will still be having regular check-ups and testing.

With a bit of luck, the cancer will stay the same, and you will live a long and happy life. But what do you do if it becomes more severe? Or if it was in a later stage from the start?

It’s time for action.

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Radical prostatectomy is the gold standard in prostate cancer treatment.

Picture, if you will, the many-headed hydra from Greek mythology. You battle this fearsome beast, cutting off its heads, only to have more grow back in their place. This is not too different from prostate cancer – on average, three to seven tumors will be growing in the prostate at once. So, instead of chopping off the heads, why not target the whole thing?

Radical prostatectomy is the most effective cure if the cancer is confined to the prostate. It’s considered the gold standard in treatment, and if done by an experienced surgeon, negative side effects like impotence and incontinence can be rare.

So, who is this for? The top candidates for radical prostatectomy are otherwise healthy men who are expected to live for another 15 years or more, and whose cancer is deemed curable. If someone is expected to die from other old-age-related diseases before a cure is necessary, the surgery may not be worth it.

These days, this kind of surgery is not something to be scared of. Recent changes in technology and approach ensure that minimal damage is done to the surrounding area, and urinary control and sexual function are minimally affected.

It’s also possible to perform the surgery using a laparoscopic procedure. Don’t let the fancy word confuse you, it just means that the surgery is done through small holes, with the guidance of a fiber-optic camera.

Laparoscopy can be made more precise through the robotic-assisted approach. This involves a 3-D sensing camera, and an externally controlled, extremely precise surgical system. But it’s important to remember that even with this method, there is still a dedicated and skilled surgeon controlling every moment of the operation.

And it does come down to the skill of the surgeon. If they have the training and know the anatomy, a radical prostatectomy is a great option for younger, healthy men.

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Radiation and cryo or thermal ablation are less-invasive alternatives to surgery.

For some men, surgery can be much too invasive, and the associated risks and recovery time are not worth the trouble. Luckily, several less-invasive treatments are considered nearly as effective.

One such option is radiation therapy. This basically involves shooting radiation at the prostate, causing the targeted cells to die. The right amount of radiation must be used so the cancer is killed, but not the surrounding healthy tissue. Luckily the method has been finetuned over the years, and it is now extremely accurate and precise. The patient wears a custom-made body suit so they remain completely still, and the same position can be reproduced for each dose of radiation.

A variation of this is brachytherapy, which involves inserting radioactive seeds into the body, to gradually attack the cancer over time.

However, radiation therapy is not without its complications. After three to five weeks of treatment, many men may experience fatigue and need to go to the bathroom more. There are also long-term effects – damage to the small blood vessels can make it difficult to get an erection over time.

Another non-invasive option is cryo or thermal ablation, which involves heating or freezing the prostate. This method is a bit newer, and there are fewer long-term studies comparing it to surgery and radiation therapy. Advocates for this option point out that it is an easier experience, with fewer side effects. However, there is a greater risk of missing the cancer, so the other options are often preferred. A doctor might recommend cryo or thermal ablation if the patient has a larger and more serious tumor, or if the cancer has returned after radiation therapy.

Once again, the best option for you is specific to your unique situation. However, take comfort in knowing that these less-invasive methods exist, and in the right situations can be as effective as surgery.

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Hormone therapy is useful in extreme cases, but shouldn’t be the primary treatment.

There is one remaining avenue to explore when looking at treatment options: Hormone therapy.

The treatments you’ve seen up until now are most effective for treating lower-grade, localized prostate cancer, which is still contained to the prostate. Because hormone therapy does not actually cure the cancer, it should not be used as the primary treatment in these situations. However, hormone therapy becomes essential when the disease is metastatic, meaning it has spread to other parts of the body.

So, how exactly does it work? Hormone therapy shuts down the hormones that feed the prostate, and consequently, the cancer. The most effective way to do this is to surgically remove the testicles, which is obviously not a desirable choice for many men. Luckily, the effect can also be achieved medically with the appropriate drugs.

The thing with hormone therapy is that it doesn’t stop the clock. If the cancer has spread to the bone, or it’s so large that it’s blocking the kidneys or bladder, then it is the perfect choice and should be started immediately – the cancer will quickly shrink and the patient will feel better.

However, if things aren’t that bad, there is no evidence that starting hormone therapy early will increase a patient’s life expectancy. Despite initially shrinking, the cancer will continue to grow over time and additional treatments may still be needed.

And the side effects may not be worth it in the long run. Because it is essentially restricting the male hormone, the results can be loss of sexual desire, reduced muscle mass, and thinning of the bones, just to name a few. It can dramatically change how a man acts and feels, so it should not be chosen lightly.

As always, consult your doctor, and be aware of the consequences of this somewhat extreme option.

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Don’t be frightened of the future.

You’ve consulted your doctor, chosen the right treatment for your unique situation, and undergone whatever procedure was deemed best. You may be asking yourself: Will my cancer be cured forever?

For prostate cancer to be cured, two things must be true. Firstly, the cancer needs to be diagnosed at a stage where it is curable – meaning it hasn’t established itself outside of the prostate. Secondly, the treatment has to work. If these conditions are met, a complete cure is possible.

However, unless the prostate has been completely removed, there is always the possibility that cancer can spring up again, by the same factors that caused it to appear in the first place.

After treatment, it is important to keep having your PSA checked regularly. Studies show that if your PSA level is undetectable 10 years after surgery, then you are unlikely to die of prostate cancer.

What about living with the side effects of treatment? One of the most troubling problems for men after surgery or radiation therapy is erectile dysfunction. Unless the treatment involved hormone therapy, this is a purely mechanical problem. The good news is that erectile dysfunction can be treated, and most men can recover sexual function.

And there is always hope. Even in patients who are unresponsive to hormone therapy, prostate cancer treatment and research are constantly advancing. New drugs and agents are being clinically tested and made available all the time, and the future is nothing but hopeful in the ever-changing world of prostate cancer.

So no matter your journey, the most important thing is to face the future with optimism and courage. You are not alone, and there’s never a reason to give up.

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The story of prostate cancer is constantly changing and being retold. Only a few decades ago your options would have been limited and extremely brutal. Now we know enough to be able to confidently monitor a confirmed cancer using active surveillance if it isn’t an immediate threat.

And more aggressive treatments such as radical prostatectomy and radiation therapy are tested and reliable enough to let us face the disease head-on. Even the less preferable option of hormone therapy offers promising results in the later stages of cancer.

While risks can be minimized with a healthy lifestyle, it’s important to remember that when the cancer is still curable, it is silent. The most important thing that any man can do is simply get checked.

Go ahead and call your doctor today – it just might save your life.

[Paul Wiley · Rating 5 out of 5]

Scariest book I've ever read. The most informative book I've ever read. This "study guide" help me decide what direction I was choosing when dealing my newly discovered cancer. The book I feel is a little biased on removal but I understand why. Best of luck and wishes on future readers. You will get better.

[P.J. Sullivan · Rating 3 out of 5]

This book is repetitive—it could be shorter than it is. The edition published in 2001 might not be up to date. It is orthodox in its approaches to cancer. It presents prostate cancer as very complicated, which no doubt it is. It cites studies that contradict one another. It admits that much about prostate cancer is unknown. It presents prostate cancer as largely genetic in origin, whether from inherited genes or from oxidative damage to genes. It presents hormones as less significant than genes. It discusses lifestyle factors, diet, and treatment options in detail.

Where does it leave the reader involved with this disease? In a quandary. But that may not be the fault of the book.

On page 136 it states that prostate biopsies are not painful. That is not what I’ve heard, and it makes me wonder if this book is leveling with readers. On page 160 it describes a radioactive injection as “harmless.” Really? But a readable and authoritative book by a professional.

[Johnrh · Rating 5 out of 5]

The definitive guide to those facing prostate cancer. Written in layman's language, easy to understand. Somewhat lengthy. Read the chapters that apply to your situation and others that interest you. A MUST read for those facing treatment. I highly recommend it. (I'm a prostate cancer survivor, 2 years post- prostate removal.)

[Denise Messenger · Rating 4 out of 5]

For anyone diagosed with prostate cancer this book is a good read for understanding the disease, aspects of prostate cancer, including probably causes, prevention, diet, etc. We make headway every day with new tests and treatment options. This book was written in 2001 was unless there is an updated version, I am sure there are new tests out and ways to treat it.

[Elizabeth Good · Rating 5 out of 5]

Excellent book- whether you are a patient or have a loved one diagnosed with this terrible disease- this informative book about Prostate Cancer is a must to have in your home. You'll refer to it again and again.

[Donnie Collins · Rating 5 out of 5]

This book has helped me very much as i battle prostate cancer. I was able to make the treatment decisions that were needed for me. I recommend this book for any man facing or dealing with prostate cancer.

[Frank Hoppe · Rating 5 out of 5]

An excellent guide to a condition that will affect you or someone close to you if you live long enough.

Although it’s over 500 pages, it’s still just over $20, and it’s organized with a “Cliff Notes” style synopsis at the beginning of each chapter.

[Andrew Reynolds · Rating 5 out of 5]

If you know anyone with prostate cancer, this is the book to read. Great information - more than most doctors will tell you.

[Tara · Rating 5 out of 5]

This is well written in layman's terms. It's everything you need and should know. I would recommend this to everyone with prostate cancer and everyone with a loved one with prostate cancer

[Philip]

This book is the definitive guide to prostate cancer....up to date and covers every stage and situation to make informed decisions on treatment based on multitudes of situations and surgeries.

[Jessie Wheeler · Rating 4 out of 5]

I like this, it was informative, without talking down to the layman.

[Synthia Salomon · Rating 3 out of 5]

The story of prostate cancer is constantly changing and being retold. Only a few decades ago your options would have been limited and extremely brutal. Now we know enough to be able to confidently monitor a confirmed cancer using active surveillance if it isn’t an immediate threat.

And more aggressive treatments such as radical prostatectomy and radiation therapy are tested and reliable enough to let us face the disease head-on. Even the less preferable option of hormone therapy offers promising results in the later stages of cancer.

While risks can be minimized with a healthy lifestyle, it’s important to remember that when the cancer is still curable, it is silent. The most important thing that any man can do is simply get checked.

[Brian Lyke · Rating 5 out of 5]

Great information for men diagnosed with PCa (also for loved ones that want to learn more about the disease). I read the previous edition when diagnosed with advanced disease and was very disheartened after reading it since it was a bit outdated. This version has very up-to-date information including many of the newer treatment protocols and introductions to ones that may be coming soon. The recent advanced in therapy are very promising and give newly diagnosed men a more complete view of things to investigate. However, this is simply one tool in the box, make sure you have a team of practitioners, potentially ROs and MOs depending on stage and treatment options.

[Jim]

I had a prostatectomy in 2016; I think it was 2013 that I read Dr. Walsh’s book, so I didn’t read the latest edition. The edition that I read didn’t know about the DaVinci robot for prostatectomy: I assume because it was written too early. I remember discussing it with Dr. Peter Carroll who disagreed with some of Dr. Walsh’s positions, perhaps because I was only familiar with an earlier edition. I read the book too long ago to give it a star rating, which, again because of the age of the edition I read, would be unfair even if I rememebered it well.

[Brian Proffit · Rating 5 out of 5]

This is the definitive work on male prostate cancer. It’s more of a reference volume than a read-through, and something in which people will likely focus on specific portions. With the release of this 4th edition, it remain the most current exhaustive resource available on what we know about the disease and the efficacy of various treatments. I strongly suggest that you don’t allow anyone you know to go through this disease without the knowledge in this book.

[Dr. Ashori · Rating 3 out of 5]

This book has the tone of being very, very aggressive from a medical perspective. It's heavy on testing and heavy on treatment. At least from what I understand about prostate cancer is that we are doing more harm than good with excess testing and treatment. However, once you have decided that you want to do everything possible to catch any prostate cancer and treat it as aggressively as possible this book is then absolutely essential.

[Buddy McFelea · Rating 5 out of 5]

An excellent read and source of information for anyone facing the diagnosis, treatment and after effects of this disease. I actually read this book 6 months after my robotic surgery. Still a wealth of information!

[Amelia Dorn · Rating 4 out of 5]

This book was invaluable to my husband and me as we navigated his journey out of stage 3 prostate cancer. It was easy to understand and navigate through, we didn’t feel we needed to read every single page or in any particular order.

[Tom · Rating 5 out of 5]

I'm updating Goodreads with some books that I read some years ago and reviewed on Amazon.

I read this book before my surgery in May of 2015. I briefly said the following on Amazon.

An important book for any man, especially after being diagnosed with prostate cancer.

[Carl Sweet · Rating 5 out of 5]

Very thorough and informative. Highly recommend for any man diagnosed with prostate cancer to help in their understanding the disease and help in their decision for treatment.

[Rob Britt · Rating 5 out of 5]

Good book very informative written well. very readable and not like a textbook, which I was afraid of. information was concise and well organized.

[Margot Timbel · Rating 5 out of 5]

Incredibly useful. Make sure you get the most recent edition published in Oct 2023.

[Tom Johnson · Rating 4 out of 5]

I have a nodule, found during a DRE, now I need a biopsy (which is in itself no small matter). Knowing little about prostate cancer I felt that I needed to educate myself. It's a wretchedly complicated subject. I read the pertinent pages (300 of 500). Scratched 5 pages of notes - difficult to read as the consequences of treating the disease can be almost as dire as the cancer itself, well maybe (I should be grateful for being diagnosed during a time of advanced surgical techniques) - and that's the rub. Short of having a crystal ball there's no easy way out. ~~~ I also bought a much slimmer book, PROSTATE CANCER BREAKTHROUGHS 2014 by Jay S. Cohen, M.D. That book wasn't much better than its title ("breakthroughs" is a cringe inducing term). All the book did was to confirm what was already in Walsh's book. There is little to be gained by reading about diagnostic procedures or potential treatments that are for the most part experimental, esoteric & hugely expensive. Having said that, pages 113-119 are worth reading as they lay out the conundrum of treatment vs. active surveillance.

[Timothy Wright · Rating 4 out of 5]

The author is a urologist that does alot of prostatectomy surgeries. As a result there is a bias towards that treatment. Very little on active surveillance. No admission or discussion of why and how PC is overdiagnosed and overtreated in America. Good overview if one is considering surgical treatment.

[Dave · Rating 5 out of 5]

Outstanding book. Goes into lots of detail.