|
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 2002, 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. |