PROSTATE CANCER TREATMENT
Prostate cancer is the most common cause of cancer in men and is the second cause of cancer-related death in men after lung cancer. In the US alone, each year over 200,000 men are newly diagnosed with the disease, and over 40,000 die from it. This article is a short overview of prostate cancer treatment options.
Who Gets Prostate Cancer?
The first obvious answer is men. That is, men over 50 years of age. At age 80, almost 50% of men have cancerous cells in their prostate, although in most cases the size of the tumor is too small to cause symptoms. African-American men are more prone to develop prostate cancer. In addition, men with a family history of the disease have an increased risk. Last but not least, diets high in saturated fats (animal fats) increase the risk of prostate cancer.
How Can I Know If I Have Prostate Cancer?
Unfortunately, prostate cancer does not cause symptoms until rather late in its course. When the tumor becomes large enough, patients may complain of urinary retention and voiding difficulty caused by uretheral compression or neurological symptoms due to spinal nerves compressions by methastases. Back pain and bone fractures are also sometimes late manifestations of the disease.
The only way to detect prostate cancer earlier, though far from perfect, is by using the two available screening tests: the
digital rectal exam of the prostate gland and the
PSA measurement.
If the screening tests are suggestive of prostate cancer, further tests are usually done, like a fine needle biopsy of the prostate with subsequent microscopic analysis of the tissue to determine whether cancer is present. MRI and bone scans are also used to determine the presence of metasthases.
The
Prostate Cancer Research Foundation of Canada has an excellent online
Prostate Cancer Risk Assessment Tool which allows you to find out whether you are at an increased risk of developing prostate cancer. What I like about it is that it addresses many of the lifestyle factors associated with cancer in general and with prostate cancer in particular.
What Treatment Options Are Available For Prostate Cancer?
Prostate cancer treatment is very much dependent on the stage of the disease. Here is a short version of the four stages:
- Stage 1: the cancer is very small and completely inside the prostate gland which feels normal when a rectal examination is done.
- Stage 2: the cancer is still inside the prostate gland, but is larger and a lump or hard area can be felt when a rectal examination is done.
- Stage 3: the cancer has broken through the covering of the prostate and may have grown into the neck of the bladder or the seminal vesicle.
- Stage 4: the cancer has spread to another part of the body.
In addition to the stage of the prostate cancer, the age of the patient is also important when it comes to treatment choice. As an example, an 85 years ol patient with a stage 1 tumor has an excellent 10-year survival chance with watchful waiting, and will not reap a significant benefit from more invasive thrapies, like surgery. Conversely, in a younger patient with localized cancer, surgery may be an excellent option capable of curing the disease.
Prostate Cancer Treatment: Watchful Waiting
As mentioned above, watchful waiting is simply observing the progress of the disease without taking aggressive therapeutic measures. It usually is indicated for slow-growing tumours or elderly patients.
Prostate Cancer Treatment: Surgery
Surgery is the most common treatment for prostate cancers. There are several surgical techniques used:
- Radical Prostatectomy - this basically means the surgeon removes the whole prostate gland. It is the preferred choice for younger, healthy men, with localized disease. The procedure have significant side-effects, such as incontinence, infertility and erectile dysfunction (impotence). Newer, nerve-sparing procedures may reduce the risk of these complications.
- Orchiectomy - this is the actual removal of the testes in an attempt to cut the testosterone production that has a stimulating effect on prostate cancer. It is a mutilating procedure, reserved usually for advanced, methastatic disease.
- Cryosurgery - this is a newer technique in which liquid nitrogen is circulated through small hollow-core needles inserted into the prostate, causing tumor cell destruction by freezing.
Prostate Cancer Treatment: Radiation Therapy
Radiation therapy is widely used and indicated for most forms of prostate cancer. It is an alternative to radical prostatectomy, although it is not clear yet whether it has the same rates of success.
Several radiation techniques are used:
- External Beam Radiation Therapy. This requires specialized equipment for delivering radiation to the prostate gland. It is performed 5 days a week for 6 - 8 weeks. Common side effects include bladder irritation, diarrhoea and impotence.
- Proton Beam Therapy - is another form of external-beam radiation treatment pieneered by Loma Linda University in California. This is a high tech form of treatment, with definite advantages over the traditional radiation therapy. Compared to an x-ray beam, a proton beam that is delivered with sufficient energy has a low "entrance dose (the dose in front of the tumor), a high-dose region, which is designed to cover the entire tumor, and no "exit dose" beyond the tumor. In contrast, X-ray beams may deposit most of their dose in tissues in front of the tumor.
- Brachytherapy - this consists of implanting small pellets of radioactive substances directly into the prostate tissue. These pellets gradually lose their radioactivity over a period of months. The advantage of this technique is less damage to the surrounding tissues. It is not indicated in advanced prostate cancer.
Prostate Cancer Treatment: Hormone Therapy
The purpose of hormone therapy is to lower testosterone levels. While hormonal therapy does not kill cancer cells, it reduces he size of prostate tumours in about 80% of men.
For many men, it will be recommended as well as surgery. It is sometimes used before radiotherapy (see below) to reduce the size of the tumour.
Hormone therapy lowers testosterone levels in different ways. Finasteride (Proscar), for example, blocks the conversion of a natural chemical into active testosterone. Alternatively, orchidectomy - surgical removal of both testicles, stops the production of testosterone.
Dr Gily
