You have been diagnosed with prostate cancer. Now, what do you do? There is no one right answer; many things need to be factored in.

An important factor is your age at the time of diagnosis. In most cases, prostate cancer is very slow growing. So if you have been diagnosed with it and you are around 70 years old and the capsule around the prostate is intact, rejecting surgery and radiation may be the best approach. Most men die with prostate cancer, but not from it. On the other hand, if you are 50 when diagnosed, you may wish to be more aggressive.

For the purpose of our discussion let us assume that you around 65 years old and have been having regular screenings and are diagnosed with prostate cancer confirmed by biopsy. The most common treatments are removal of the prostate gland, external beam radiation to the prostate area, radiation seed implantation, cryosurgery and hormonal therapy. Some doctors will recommend “watchful waiting” if the cancer has not spread beyond the prostate. It is only when cancer spreads that it is life threatening. Physicians will often rely on what is called the Gleason score. The pathologist will “score” the cells of the biopsy sample as they appear under a microscope. The higher the score, the more virulent the cancer and thus, it is thought, the more aggressive one should be.

The word cancer is very intimidating, and the first thing I would recommend is not to panic. Look at all options so that you can make an informed decision that is right for you. I believe that regardless which treatment option a person selects it is very important that the patient be comfortable with the choice he has made.

Common treatments.

Below are the more traditional approaches to treating prostate cancer.

Surgery-radical prostatectomyThe entire prostate gland is surgically removed. Supposedly removing the gland will remove the problem. However this is not necessarily true. It is interesting to note that PSA tests continue to be done even after prostate removal; these are done to monitor whether or not the cancer returns. I view cancer as a true systemic problem. Thus, whatever treatment you decide upon, I feel the whole person must be treated. I am not talking about chemotherapy; I am talking about other helpful methods, which I will discuss next month.

If you have a low-grade cancer and are over 65 and choose to do nothing, your life expectancy will be the same as anyone else. Surgery for prostate removal is not without potential risk, the most serious two resulting complications being incontinence and impotence.

Radiation-external beam radiationRadiation is beamed through your abdomen to the prostate and often to the surrounding area. Normally the treatment is given five days per week for 6 to 8 weeks. Again, impotence and incontinence are potential side effects, along with radiation sequelae like nausea, fatigue, diarrhea, radiation burns, and insomnia. If “every cancer cell” hasn’t been killed by the radiation, the cancer can come back, but you will not be able to have radiation treatment again, because too much radiation causes cancer! With external beam radiation treatment, incontinence occurs about 10% of the time and impotence 29 to 49% of the time depending on the study. Cancer can re-occur 30 to 50% of the time. The external beam radiation is used when cancer is confined to the gland, and it can be used alone or combined with surgery or medications.

Brachytherapy-Internal seed radiationTiny radioactive seeds are placed into the prostate via small needles. This procedure is done in a few hours as an outpatient. This is a more focused treatment and there is less chance of both impotence (about 20%) and incontinence. Some prolonged urinary difficulties may occur. Recurrence is about 20%.

Hormonal blockade therapyThe idea here is to stop the production of the male sex hormone, especially testosterone, which the prostate needs for growth. It is thought that testosterone feeds the cancer, thereby aiding its spread. Thus this treatment is not used to kill the cancer but rather to halt or slow it down. Various methods are employed to lower the testosterone; these include castration, drugs or estrogen. The question, I think that needs to be asked is, “If testosterone increases prostate cancer, then why don’t teenagers, with raging testosterone, get prostate cancer?” In fact, a Swedish study has shown that the risk of prostate cancer was actually lower in men with high testosterone levels. Some of the side effects of this therapy include loss of libido, fatigue, weakness, osteoporosis, joint pains, poor memory and mood swings. This therapy is usually combined with a prostatectomy or radiation.

CryosurgeryBoth the normal prostate tissue and the cancerous tissue are frozen. A probe with liquid nitrogen circulating through it is used and the tissue is cooled to minus 20 degrees Celsius. Again, the major complications are impotence, urinary obstruction and incontinence.

RFA-radio frequency ablation.Radio waves “cook” the tumor via a tiny probe inserted into the prostate. This works on tumors of less than 3 cm. The risk of incontinence and impotence is fairly low.

HIFU-high intensity focused ultrasoundVery focused pulses of ultrasound destroy the prostate cancer and spare the surrounding nerves, so the incidence of incontinence (1%) and impotence (10-15%) are low. The cancer recurrence rate here is about 20%. This procedure works by raising the temperature of the focused ultrasound beam, which is pinpoint in size, to 185 degrees Fahrenheit. The high temperature destroys the targeted cells.

The prostate cancer survival rates vary greatly depending upon the stage at which the cancer was diagnosed, and upon the treatment used. For instance, external beam radiation therapy, which is usually used adjunctively to improve the success rate of other therapies, has a five-year success rate of 84% to 86% if done on a patient with a low-risk level of prostate cancer; 26% to 60% for someone with a moderate level; and 19% to 25% for those in a high level category. Prostatectomy has a success rate of 76% to 98% for those considered at low risk; 60% to 76% for moderate risk patients; and 30% to 70% for those at high risk. The large differences in success vary upon the study and just complicates matters as you try to decide upon the treatment that you feel is best for you. Of course, I feel that treatment outcomes will be enhanced by natural, whole body treatments.

Early detection is the best way to insure survival. Dr. Robert Bard, a radiologist in New York City, who uses the 3-D ultrasound with color Doppler has told me that when he picks up a low-grade cancer and has his patients take certain supplements, he finds that 80% of the time there is resolution of the cancer or no progression.

Naturally in a newsletter such as this, I can’t go into great depth; I just wanted to present an overview of the standard treatments. Next month, I will discuss alternative and complementary approaches to the treatment of prostate cancer.

© 2008, Mark A. Breiner, DDS

The information presented is for educational purposes only. You should consult a qualified health practitioner for diagnosis and treatment.

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