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Summery
of Treatment Options
| In 2000, approximately 180,000 American
men were diagnosed with prostate cancer, and nearly
32,000 men died from this disease. As the second
leading cause of cancer-related mortality in men,
prostate cancer remains a major health issue. However,
due to advances in detection and treatment, the death
rate is dropping for the first time in history. |
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Some patients with newly diagnosed prostate cancer
will have features that suggest an aggressive tumor.
These patients typically have either a PSA level
higher than 20, a high grade (or Gleason score) of
cancer, or tumor that obviously extends out of the
prostate on exam. For these patients, there is a high
likelihood that the cancer has spread microscopically
and that a treatment localized to the prostate gland
will not cure them. The standard approach for most of
these patients is to undergo treatment with a
combination of hormonal therapy and external beam
radiation therapy. In addition, a number of centers
around the country are investigating new approaches
using chemotherapy and/or hormonal therapy with
surgery. In the future, new drugs may be tested in
these patients for evidence of a beneficial response.
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Some men who have surgery to treat their prostate
cancer will later have a relapse of their disease,
usually detected by a rising PSA level. Prior to
starting hormonal therapy , some of these men may
elect to pursue investigational strategies to delay
progression of the tumor. In general, these approaches
have little to no side effects and are therefore
better tolerated than hormonal therapy. The rationale
is to delay progression of the cancer and postpone the
use of hormonal therapy, since this is not curative
and inevitably leads to hormone-resistant disease.
Strategies include vaccines to strengthen
the immune system's response to the cancer cells,
inhibitors of blood vessel growth (anti-angiogenesis),
inhibitors of the cancer's ability to spread
(metastases) such as metalloprotease inhibitors, and
agents to change the aggressiveness of the cancer
cells (differentiation agents). The advantage is the
possibility that cancer progression will be delayed,
while the disadvantages relate to treatment side
effects, which vary from drug to drug.
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Treatments
for prostate cancer are constantly being refined to reduce
side effects and increase effectiveness. The following is a
basic overview of existing treatments; the Prostate Cancer
Options does not endorse any particular one, nor does it
advise individuals on the course of their therapies. However,
Prostate Cancer Options urges patients to learn all they can
about all available options. We offer free consultation to any
patient who suspects they may have prostate cancer as well as
patients already diagnosed with this disease. There are
several options and although we don't endorse anyone we are
always willing to explore new possibilities and discuss
treatment options with you.
Common treatments for prostate cancer include the following:
Surgery: Performed where
tumors are still confined within the prostate, surgery is
intended to effectively cure the cancer by removing all
cancerous tissue. A radical prostatectomy is the removal of
the entire prostate gland; a transurethral resection of the
prostate (TURP) is the removal of the portion that surrounds
the urethra. Two types of anesthesia are generally used: 1)
general, in which a patient is completely unconscious, or 2)
epidural, in which a spinal block is administered to numb a
patient's lower body. Surgery carries a risk of incontinence
and impotence. But advances in nerve-sparing surgery have
reduced these, and other side effects. One of the surgeries
most used by this center is the
as it is less invasive and promotes quicker healing. Click the
LRP link above to read more.
Radiation therapy is usually
given to patients whose disease is confined or immediately
outside the capsule of the prostate. Radiation is used to
control the disease, but it is also used in advanced cases to
ease pain. Radiation therapy can be delivered from outside the
body (external beam or conformal therapy) or by implanting
radioactive beads or other material in the prostate (seed
therapy or brachytherapy). Radiation works by damaging all
cells that divide quickly. Along with eliminating cancerous
cells, radiation can damage cells in the lining of the
intestine, which can lead to controllable side-effects. New
computer imaging techniques help focus the radiation beam on
the tumor, away from healthy tissue.
Hormone therapy seeks to
control prostate cancer by limiting the supply of hormones
that cancer cells need to grow. It is used in advanced cases
in which the cancer has spread outside the gland. Doctors can
reduce or eliminate the supply of testosterone by
administering anti-androgen drugs or LHRH analogs or by
surgically removing the testis. Side effects vary but may
include impotence or loss of sexual desire, breast tenderness
or swelling, diarrhea, tiredness, and signs of osteoporosis.
Chemotherapy uses toxic drugs
to slow or reverse the spread of the disease in advanced
cases. These drugs, which are injected into the blood and
poison rapidly dividing cells, also affect healthy dividing
cells in the blood, intestine and hair. Common side effects
include nausea, hair loss and anemia. Side effects are often
alleviated through the use of other drugs.
Experimental therapies:
Scientists are now testing a number of promising therapeutic
approaches that are only available to patients enrolled in
clinical trials. These therapies include anti-angiogenesis
compounds, designed to eliminate tumors by targeting their
blood supply; gene therapies, which seek to normalize the
genetic function of cancerous cells; immunotherapies, which
help activate the body's natural defense mechanisms against
prostate cancer; and therapies designed to stimulate
apoptosis, or programmed cell death.
No treatment: "Watchful
waiting" is based on the presumption that the disease
should only be treated if it will reduce symptoms, prevent
progression or prolong the life of the patient.
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