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Treatments


Some Early Methods Show Promise 
   

Treatments of Prostrate Cancer

Stages Characteristics Type of Treatment
T1 or T2 Cancer is localized in the prostate Surgery, radiation therapy (radiotherapy), watchful waiting
T3 or T4 Cancer is locally advanced Radiation therapy; combination of hormonal therapy and radiation
N+ or M+ Cancer has spread to pelvic lymph nodes (N+) or distant organs approaches
(M+)
Hormornal therapy, experimental

The Partin Coefficient Tables, originally developed at the Brady Urological Institute of The Johns Hopkins Medical Institutions, are sometimes used to offer estimates of four different items that may be important in deciding how to treat a patient:

  • The probability that the patient has completely organ-confined disease
  • The probability that the patient has "established capsular penetration,” which means that the prostate cancer has extended into and perhaps through the capsule of the prostate
  • The probability that the patient has extension of his prostate cancer into the seminal vesicles
  • The probability that the patient has prostate cancer that has spread into the lymph nodes

While the data is not definitive, these calculations can have an impact on how the physician and the patient arrive at a treatment decision. Detailed information about the Partin Coefficient Tables is available on two web sites:

Prostate Pointers
Vox Medica

 
How is Prostrate Cancer Treated?

The stage of a prostate cancer reflects the extent of the cancer: how big it is and whether it has spread. T1 and T2 cancers are confined to the prostate gland. T1 refers to a tumor that is not felt during a DRE (digital rectal examination) but cancer cells are found. T2 refers to a tumor that the doctor can feel by DRE. T3 cancers have grown beyond the gland itself and spread to the surrounding tissues. T4 cancers have spread beyond the seminal vesicles and into the pelvis or rectum. Cancer that spreads elsewhere, regardless of the extent of the local tumor or “T stage”, is classified as N+, if it has spread to the lymph nodes and M+, if it has spread to other distant areas.

The doctor should explain the treatment options, if a diagnosis of prostate cancer is made. Various treatments may include surgery, radiation therapy, hormonal therapy, and occasionally chemotherapy. The doctor will advise you of the treatment that is most appropriate for your particular case. Treatment of early-stage prostate cancers may not be necessary in some patients who are very old or very ill. Watchful waiting has been advocated as a reasonable approach for some men with prostate cancer. Although untreated prostate cancer continues to grow, it may do so quite slowly. In fact, the growth of the cancer may be so slow that it causes no problems in a particular man's lifetime, even if it is left untreated. No one can predict how long it will take a specific cancer to spread or how long a particular man is going to live. Unless a man is expected to live at least 10 years, watchful waiting with no immediate treatment may be appropriate.

Age is not the only factor to consider. Family history and other health problems also are important. Again, watchful waiting is a reasonable option for elderly men, particularly when the cancer is small and appears to be low grade. Studies show, however, that prostate cancer may be a significant threat to life or health within 10 years if the cancer is of a higher grade or advanced stage.

Surgery performed for treatment of localized prostate cancer is called "radical prostatectomy."
 
Through a vertical incision in the lower abdomen or behind the scrotum, the entire prostate and seminal vesicles are removed. When the cancer is confined within the tissues removed at surgery, radical prostatectomy can cure localized prostate cancer. The PSA level in the blood should fall to undetectable levels (near zero) shortly after radical prostatectomy, since the entire prostate has been removed. PSA then becomes an excellent test to detect even small amounts of cancer left behind after surgery. Either of two approaches can be used for surgical removal of lymph nodes:

1) In surgical lymphadenectomy, pelvic lymph nodes are removed through an incision in the lower part of the abdomen. This is usually done at the time of surgery to remove the prostate.

2) Alternatively, a laparoscope (a miniature telescope connected to a TV monitor) can be used by a doctor to look at and remove the lymph nodes through four small incisions in the lower abdomen. Removing lymph nodes using a laparoscope usually requires a much shorter stay in the hospital than does open surgical lymphadenectomy. But you also may require a second surgical procedure if the nodes are negative. This is usually done only when there is a high risk that the tumor has spread to the lymph nodes.

There are risks and side effects associated with surgery. About 1 of every 200 to 400 men die from complications such as heart attacks or blood clots related to the operation. Patients are usually in the hospital for two to four days after a radical prostatectomy and wear a Foley catheter (a tube through the urethra and into the bladder to drain urine) for two weeks afterward. Most patients have at least some degree of incontinence (leakage of urine from the penis) for up to two or three months after surgery. The great majority of men eventually regain good urinary control after surgery.

Impotence is sometimes a side effect of radical prostatectomy. The nerves that help cause erections lie very close to the prostate. These nerves can sometimes be spared during surgery, depending upon the location of the cancer. If the nerves can be spared, recovery of erections is best in younger patients who had no difficulty achieving erections before surgery. For men who do have problems with erections after surgery, there are a number of ways to help restore erections and the ability to have sexual intercourse.

Radiation therapy is another effective treatment for localized prostate cancer. The radiation can be administered externally or internally with radioactive seed implants (brachytherapy) or with the two in combination. External beam radiation therapy is usually delivered on an outpatient basis for seven to nine weeks. This treatment utilizes a machine that generates high energy X-rays. There appears to be no major difference between the two treatments in the percentage of men still alive ten years after treatment. Whether there are differences in results after that time is uncertain.

Interstitial irradiation (Brachytherapy) involves the permanent placement of radioactive “seeds” inside the prostate. Different types of radiation seeds are used, and there is not agreement on which type is best. Interstitial irradiation for prostate cancer has been used for more than 20 years. Previously, the radiation sources were implanted into the prostate through a lower abdominal incision, but the results were not as good as those obtained with other treatment techniques. Today radiation seeds are inserted using needles through the skin.

There are side effects associated with radiation therapy. Some degree of discomfort with urination, frequent and urgent urination, and diarrhea are common during radiation therapy. Side effects are especially likely during the second half of the treatment course. In most patients, these symptoms usually go away within a few months. Men treated with radiation therapy for prostate cancer may eventually become impotent. As is the case with patients treated by radical prostatectomy, younger and more sexually active men are more likely to remain potent.

Hormonal therapy may be useful because prostate cancer cells depend, at least partially, upon male hormones for growth. Testosterone is the most important of these hormones.

Treatment that deprives the cancer cells of testosterone can slow the growth of prostate cancer. Hormonal therapy can consist of either surgical removal of the testes (orchiectomy) or monthly injections of a drug called luteinizing hormone releasing hormone (LHRH) analog, which blocks the production of testosterone by the testes. Sometimes an oral drug called an anti-androgen is used in combination with surgical castration or an LHRH analog. Anti-androgens block the effects of any remaining male hormone produced elsewhere in the body, particularly male hormones produced by the adrenal glands.

Hormonal therapy is not considered a curative form of treatment, but rather, a way to temporarily slow the growth of prostate cancer cells. Hormone therapy usually is not used unless there are signs that the cancer has spread beyond the prostate. Hormone therapy causes hot flashes in about half of men and usually produces impotence and loss of libido (sexual desire). Hormonal therapy also may be used in conjunction with radiation therapy.

 
"It is estimated that during 2005, over 15,000 cases of
prostate cancer will be diagnosed in Florida and almost
3,000 men will die of this silent killer."


Bob Samuels - Founder Florida Prostate Cancer Network

As a result of attempts to decrease cancer reoccurrence and the side effects of treatment, several new treatment methods for localized prostate cancer have emerged and are gaining acceptance. Cryosurgery involves freezing the prostate and has been used in one form or another for more than 50 years. Previous results with this technique were less than satisfactory. However, a new probe for prostate freezing is being tested, along with better methods for delivering freezing temperatures to the prostate while protecting the urethra. Early results are encouraging, but long term effectiveness and safety are unknown.

Although some of the methods being tested may show early promise, they are currently unproven. Doctors need to treat many more patients and see how they respond before it is known whether these new approaches are effective in treating prostate cancer. A man with prostate cancer must work with his doctor to decide which tests and treatments are right for him. You should discuss these, and any other questions that you have, with your doctor.

 

Florida Prostate Cancer Network is a Florida non-profit organization,Federal Tax ID 59-3545266

Disclaimer

"The information that FPCN provides is general and informative. 
FPCN's information should not take the place of the advice from your doctor."