Treatment Options Are Many for Prostate Cancer
FRIDAY Dec. 5, 2008 -- A diagnosis of prostate cancer may prompt an understandable feeling of dread, but patients actually have a wide array of options at their disposal for tackling the disease, medical experts say.
There are so many options that a man's quality of life should be considered strongly when weighing various procedures. In fact, a growing number of doctors say many prostate cancers are better off being left untreated.
"It's been said that more men die with prostate cancer than of prostate cancer," said Dr. Durado Brooks, director of prostate cancer for the American Cancer Society. "For a significant number of these men, if they have other health problems that are likely to shorten their life span, in many instances they aren't likely to live long enough for the prostate cancer to cause them any problem."
The survival rate of prostate cancer is very high. Overall, 99 percent of men diagnosed with prostate cancer survive at least five years, according to the American Cancer Society.
Furthermore, 91 percent of all prostate cancers are found while they are still within the prostate or only in nearby areas. The five-year relative survival rate for those men is almost 100 percent.
"Prostate cancer is very survivable," said Dr. Terry Mason, commissioner of the Chicago Department of Public Health and a volunteer member of the American Cancer Society Prostate Cancer Advisory Group. "It's a very treatable disease."
But depending on the type of treatment selected, a prostate cancer patient can suffer some rather uncomfortable side effects, among them impotence and incontinence.
Surgery that removes the tumor can result in impotence, if the nerves that control erection are damaged during the procedure, according to the U.S. National Cancer Institute. The patient also could suffer short-term incontinence while he recovers from surgery.
Radiation treatment can cause both bladder and bowel incontinence. It can also lead to impotence, although that effect does not take place immediately.
"Men may start out being sexually active, and then as the radiation scarring and damage develops over the next two to three years, there's a gradual decrease in the levels of potency," Brooks said. "With surgery, it's the opposite. There is some initial difficulty, and then things improve over time."
Within each type of treatment, there's also a menu of options with an array of pluses and minuses.
For example, surgical patients can opt for a "nerve-sparing" procedure less likely to interfere with sexual function. And radiation patients can choose between external beam treatment and brachytherapy, in which radioactive "seeds" are implanted in the tumor, according to the American Cancer Society.
"There is no proven best treatment," Brooks said. "They need to investigate all the treatment options, and understand all the up sides and potential complications from each option."
A patient also might decide that it's just not worth getting treated, particularly if the tumor is slow-growing.
In a tactic called "watchful waiting," the patient does not receive treatment. Instead, regular checkups monitor the progress of the cancer.
If the man's life expectancy is low due to old age or other factors, surgery or radiation for prostate cancer might actually do more harm than good, some doctors feel.
"I have that conversation a lot with the older gentlemen, particularly those guys over 75 years old," Mason said. "Those are the guys who really have to weigh whether it's worth it."
New vaccine therapies to attack prostate cancer could be on the horizon, Brooks said. There are two or three vaccines under development that would prompt a patient's immune system to target cancer cells.
A phase 1 trial of one vaccine appeared to promote immune responses in 70 percent of the patients involved, according to a recent study.
However, Mason said those drugs are still many years and many, many dollars away.
In the meanwhile, there are steps men can take to limit their chances of getting prostate cancer.
For example, some studies have shown that chemicals released from muscle proteins when they're cooked at high temperatures could increase risk of prostate cancer in some, Mason said.
Other studies have shown that a diet rich in animal fat or meat could be linked to incidence of prostate cancer, according to the National Cancer Institute.
"Before I would put my money in a vaccine, I would want to think about some of the dietary things people can do," Mason added.
To learn more visit the U.S. National Cancer Institute.
Posted: December 2008