Prostate Cancer Feature

Coping with Prostate Cancer: A New Guide to Treatment

Prostate cancer is the most common non-skin cancer in the US, and the statistics about it are alarming: After lung cancer, prostate cancer is the leading cause of cancer-related deaths among men. In 2005, over 232,000 men will be diagnosed with prostate cancer, and over 30,000 men will die from it.

The good news is that prostate cancer is highly treatable. In its early stages, prostate cancer may be eliminated by surgery or radiation. However, because the disease usually has no symptoms, early diagnosis requires testing, including a prostate cancer screening-test- such as the PSA blood test- and digital rectal exam.

But what happens after the diagnosis? Choosing among the many options isn't easy. Libraries, bookstores and the Internet are full of conflicting information about the best course of treatment at any stage of prostate cancer. The sheer volume of information may be intimidating, and some of it will be outdated or inaccurate.

Your doctor will have an opinion, but even doctors' opinions differ, particularly among different medical specialties. How do you decide on the best course of action?

Report to the Nation - A Helpful Guide

The Prostate Cancer Foundation has just published a guide for prostate cancer patients and their families. Their newly released Report to the Nation on Prostate Cancer: A Guide for Men and Their Families delivers a concise summary of prostate cancer diagnosis and treatment issues -and it's free of charge. (Order a free copy here.)

The guide is designed to help men with prostate cancer and their families work effectively with their doctors to choose the course of treatment that is right for them.

"We need this [guide] because 230,000 men are diagnosed with prostate cancer every year," said Leslie Michelson, chief executive officer of the Prostate Cancer Foundation. "There is an explosion of information."

Written by a diverse team of medical professionals, Report to the Nation addresses treating prostate cancer at different disease stages, and reviews standard treatment approaches and emerging therapies. The guide also includes a workbook-like section at the back featuring tear-out cards with important, sometimes difficult, questions that patients can take to their doctor.

"The book is a companion to discussions with your physician" co-author Michael A. Carducci, MD, a medical oncologist at The Johns Hopkins University, told Drugs.com. "The book is written in very candid language, and it does give a balanced view because we involved a surgeon, a radiation oncologist, a surgical oncologist and an oncology nurse.

"There are things to pull out, fill in and take in to their doctor that may be useful. Doctors often use terms such as hormonal therapy' that may be unclear - this guide defines them. And it's pocket-sized, easy to carry around."

The guide advocates talking to a variety of doctors, if possible from different specialties, to get a clear picture of options and relative pros and cons of different treatment approaches.

Enrolling in a Clinical Trial

Research about prostate cancer is ongoing, and chances are there may be a clinical trial running in your area. The advantages of enrolling in a clinical trial are various, according to Dr. Carducci.

"I'm a firm believer in the utility of clinical trials,"he says. "When patients are faced with the question of what to do next, we like to base the decision on previous research about what men have done before, in similar situations.

"Clinical trials really begin the discussion that there are uncertainties in how doctors manage patients. Participating in a trial is one step towards finding answers. The trials are typically conducted in a very safe manner-in my opinion, patients get more care because all aspects of their health are more closely monitored, and this can be very comforting."

Dr. Carducci also notes that the idea that "new is better" is not necessarily true where drugs used to treat prostate cancer are concerned. "There is a right time and place for clinical trials, for example in the patient who has surgery that proved unsuccessful.

"When a patient with high risk disease asks the surgeon, 'What do I do now?', there are few data to support what to do next. But there are clinical trials to answer that question - some including chemotherapy. Chemotherapy has shown a survival advantage in a more advanced disease setting, and is now being moved early into the disease.

"Even for advanced disease patients, clinical trials are appropriate to answer the question as to what should be done after Taxotere (a standard drug therapy) stops working. That's where newer drugs come into play - and clinical trials really make the most sense."

While appropriate at any disease stage, clinical trials are open to men with prostate cancer from the first stages after diagnosis. According to Dr. Carducci, the best time to enroll in a clinical trial is when a patient is faced with a decision about his care. If uncertainty exists as to what the best treatment choice may be, then there may be a clinical trial to answer that.

Finding a Clinical Trial

To enroll in a trial, patients must meet eligibility criteria, including geographic availability. To find out about clinical trials going on in your area, ask your doctor or check out these websites:

• American Cancer Society- Clinical Trials Matching Service
• ClinicalTrials.gov - A service of the National Institutes of Health
• CenterWatch
• TrialsCentral

INFORMATION Online

• Prostate Cancer Foundation
• American Cancer Society
• James Buchanan Brady Urological Institute
• The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Further Reading

Prostate Cancer: Prevention and Cure, by Lee Nelson, MD, Huntington Press, Las Vegas, Nevada, ©2003.

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