The standard treatment options for prostate cancer include watchful waiting, radical prostatectomy, radiation therapy, and hormonal therapy. Radiation therapy can be delivered from an external source (external beam radiation therapy) or by implantation of radioactive seeds (brachytherapy).
Radical prostatectomy and radiation therapy can potentially cure prostate cancer when the disease is detected in its early stages. Hormone therapy is not curative and is generally used to slow the progression of the disease once it has spread to other sites. Though chemotherapy is effective in treating some types of cancer, it has been less successful for advanced prostate cancer.
Here's a closer look at the various treatment options:
Watchful waiting
This is a management option in which select patients (usually older age) are closely monitored for the progression of cancer rather than undergoing immediate treatment. At Johns Hopkins, men are monitored with regular PSA measurements, digital rectal exams, and an annual biopsy. Watchful waiting also requires that a person be able to live with the cancer and not be overcome by the anxiety of careful monitoring.
Radical prostatectomy
This entails the surgical removal of the prostate gland and seminal vesicles to treat prostate cancer. The anatomical approach to radical retropubic prostatectomy, developed at Johns Hopkins, includes important modifications to reduce blood loss, preserve urinary control, and preserve delicate nerves essential for erections.
Radiation therapy
This therapy uses ionizing radiation to destroy cancer cells by damaging DNA within the cells. With external-beam radiation therapy, treatment is designed to kill cancerous tissue from outside the body by focusing a high-powered X-ray beam on the affected area a few minutes at a time, usually over the course of weeks. Intensity modulated radiation therapy (IMRT) is the newest form of delivering external beam radiation that allows for more precise delivery of calculated radiation dosage to the selected target. Interstitial brachytherapy ("seed" therapy) is another form of radiation therapy in which radioactive pellets ("seeds") are implanted into the prostate to deliver radiation directly to the tumor sites.
Hormonal therapy
This therapy entails the use of hormones to treat advanced prostate cancer, with the goal of shutting down the hormones that nourish the prostate. Some prostate cells are responsive to this, while others are not.
Key Factors to Consider in Choosing a Treatment
Men eventually make their treatment decision based on a variety of factors, including the potential for side effects, perceived long-term risks, psychological ramifications, and financial costs of each of the therapies. While aggressive treatment may prolong life, it can also damage the quality of life by compromising sexual performance and, to a lesser extent, the ability to control urination.
Ultimately, however, prostate treatment depends on two factors: the clinical stage of the cancer (the extent of disease) and the age and general health of the individual.
Researchers have found that, in healthy men who have more than a 10-year life expectancy, about 80% of prostate cancers detected by PSA testing have the potential to progress and thus warrant treatment or careful monitoring. (The PSA test, which measures prostate-specific antigen—a protein produced in the prostate and released into the blood—is widely used as a tool to screen for the presence of prostate cancer.) Still, with increased use of PSA testing, some men will be diagnosed with small prostate cancers (which cannot be felt during a digital rectal exam but are suspected from PSA tests and confirmed by biopsy) that pose no immediate threat and, indeed, may never need treatment. In a small watchful waiting study conducted at Johns Hopkins, after close monitoring and testing, only 30% of the men progressed out of the study to require treatment.
Doctors use several methods to help predict the seriousness of prostate cancer, and this information is factored into the treatment decision.
One method is the Gleason score, which ranges from 2 to 10. A score of 2 to 4 indicates a greater probability of an insignificant cancer—a cancer that is unlikely to grow rapidly and spread.
Higher scores suggest a greater likelihood of a significant, life-threatening cancer. Men with "high-grade" disease (defined as a Gleason score of 7 to 10) are considered poor candidates for watchful waiting, since the high score indicates an aggressive cancer
Another method helpful in determining the best treatment option is the Partin tables, named after the Johns Hopkins physician who developed them. The tables help doctors predict whether cancer is confined to the prostate or has spread to adjacent tissue, seminal vesicles, or lymph nodes. (You can view the Partin tables at the Brady Urological Institute web site:
http://urology.jhu.edu/prostate/partintables
php
).
The prediction is based on the patient's PSA levels, biopsy Gleason score, and TNM cancer stage, which is a system for expressing the size and degree of spread of prostate cancer by separately describing the extent of tumor at its original location (T), whether and to what extent the cancer has spread to nearby lymph nodes (N), and whether and to what extent the cancer has metastasized (M) to other sites in the body.
If cancer has spread outside the prostate, surgery may not be the best treatment option.
You must also consider possible complications when deciding on a treatment option. If a man chooses surgery or radiation therapy, he risks the possibility of bowel, urinary, or sexual problems. If he chooses watchful waiting (no treatment is provided, but the patient is closely monitored for cancer growth), he may be anxious about the progress of the disease, and urinary or sexual symptoms may arise if the disease progresses One of the side effects of prostate cancer surgery and radiation therapy is erectile dysfunction.
In Key #4, you'll learn about the benefits of the three "erection drugs" approved by the FDA.
KEY 4 is titled: Restore and Maintain Erectile Performance This Special Report is not intended to provide advice on personal medical matters or to substitute for consultation with a physician
Copyright © 2006 Medletter Associates, LLC
All rights reserved
