By Joe Tash
Dr. Jay Cohen’s mind reeled in December 2011 when he was diagnosed with prostate cancer. Should he immediately have surgery that could cause serious side effects, or move cautiously, gathering more information to better assess his options?
“Imagine being single at 66, impotent and incontinent. I cannot fathom it. On the other hand, imagine dying slowly, agonizingly, of prostate cancer. Tough choices,” Cohen, a Del Mar resident, wrote in his new book, “Prostate Cancer Breakthroughs: A Step-by-Step Guide to Cutting-Edge Diagnostic Tests and 8 Medically-Proven Treatments.”
Cohen, 67, is a psychiatrist and author, who has researched and written eight books and articles, many dealing with the side effects of medications. But, as he wrote in his latest book, when he was diagnosed with prostate cancer, he found himself in uncharted territory.
The experience led him to embark on a quest to learn as much as he could about the disease, the best diagnostic tools and recent advances in treatment options. The self-published book is available at
In the book — and in an interview — Cohen said two-thirds or more of men who are diagnosed with prostate cancer don’t need aggressive treatment such as surgery or radiation. He argued that doctors tend to “overtreat” prostate cancer, causing many men to suffer unnecessarily from harsh side effects.
In his case, Cohen said he was scheduled for surgery when he learned about a test called advanced prostate MRI (magnetic resonance imaging), which is available at only a limited number of clinics in the U.S. Another key tool, he said, is the color Doppler ultrasound. Both tests, he said, provide information about the patient’s specific cancer, which in turn can help them determine how to proceed.
After tests and second opinions, Cohen decided not to have treatment, but instead to monitor his cancer and only get treatment if his situation changes. He said many men have non-aggressive forms of prostate cancer that don’t require immediate treatment.
It’s now been 18 months since his diagnosis, Cohen said, and his cancer hasn’t advanced. He said he will need follow-up tests for the rest of his life to track any potential changes in his cancer.
His purpose in writing the book, Cohen said, is to let men know about alternatives to immediate, aggressive cancer treatment and its potential side effects. He believes that in coming years, the medical profession will embrace the approach he advocates. While surgery or radiation may be appropriate for some patients, for others treatment is unnecessary, he said.
“I’m not trying to criticize, I’m just trying to get the system to move along a little faster,” he said.
Dr. Carl Rossi, a radiation oncologist and medical director of a proton therapy cancer center that Scripps Health will open later this summer in Mira Mesa, said Cohen is correct that doctors do tend to overtreat people with prostate cancer.
But that is because doctors lack tools to determine with relative certainty two things: the life expectancy of individual patients, and how a patient’s particular cancer will behave over his lifetime.
Deciding on treatment is easier when the patient has a life expectancy of several decades and a strong likelihood of being cured, Rossi said.
The problem is that non-aggressive prostate cancer progresses over time to become more dangerous, Rossi said. The trick for doctors and patients is assessing how soon that change might occur.
Rossi noted that no “flashing light” comes on to indicate when the time for treatment has arrived.
“It’s a calculated risk,” he said, because if a patient waits too long, the cancer may progress to the point where it is no longer curable or requires even more aggressive treatment than would have been needed at the time of diagnosis.
“This question comes up all the time when I’m meeting with patients,” he said. Patients must decide whether to be treated right away and risk side effects such as sexual dysfunction and loss of bladder control, or wait and see if treatment is needed later.
Cohen and Rossi agreed on the need for men over 50 to have regular PSA, or prostate-screening antigen, tests, which can detect very early cancers. The topic is controversial, because some medical advocacy groups have said routine PSA tests can lead to overtreatment of non-aggressive prostate cancers.
Cohen and Rossi said the PSA test remains the best early warning system for prostate cancer, and that regular PSA testing has dramatically reduced death rates from the disease.
Cohen said he is confident that with regular testing, he and his doctors can keep tabs on his cancer, and determine if he needs treatment. More likely, he said, is that his cancer will remain slow-growing and non-aggressive, and treatment won’t be needed. Canceling his surgery, he said, was the best course for him.
“I feel I was lucky as hell, and yes, I definitely made the right decision,” he said.
Cohen will speak before the Informed Prostate Cancer Support Group on at 10 a.m. on Saturday, June 15. The group meets at the Sanford-Burnham Auditorium, 10905 Road to the Cure (formerly Altman Row), San Diego, 92121.