BY MARK SCHOLZ
Now that prostate cancer has become a treatable disease—like hypertension or diabetes for example—new problems have surfaced. Selecting effective treatment has become complicated by plethora of different treatment options you are presented. Here is a very brief introduction to the types of therapy available for men with newly-diagnosed prostate cancer.
It is now becoming clear that thousands of men undergo aggressive treatment every year for a type of prostate cancer that will never be life-threatening. Active Surveillance, which means that treatment is only administered if the cancer continues to grow, is becoming more and more popular for men with the Low-Risk type of prostate cancer.
Surgery, radioactive seed implantation, targeted beam radiation and cryosurgery are all local treatments, which when administered by experts, can be expected to eradicate the cancer within the prostate with a high degree of consistency. There are two potential drawbacks with all of these options. First, these treatments can cause irreversible side effects to adjoining structures such as nerves that control erections, urinary, and rectal function. Second, if the cancer has already spread outside the prostate the treatment may not cure the cancer.
Other options are designed to treat cancer both in the prostate and throughout the rest of the body. These options include herbal, hormonal, immune and chemotherapy treatments. The disadvantage of systemic treatments is that while they suppress the cancer, they usually fail to eradicate it completely. Systemic treatment aims to convert prostate cancer into a chronic, non-progressive condition and keep it stable for many years. Each type of systemic treatment is associated with its own unique spectrum of side effects.
This approach—systemic plus local treatment—is used for selected patients with aggressive prostate cancer who have a high risk of relapse with local therapy alone. Combination treatment offers the best chance for cure in patients with disease that has already spread or metastasized outside the prostate.
The aggressiveness of each individual’s cancer is determined by typing. The extent and grade of the cancer can be estimated with blood tests, biopsy information and scan results. For more details about “typing” your cancer see the brochure titled What’s Your Type available at pcri.org.
Prostate cancer patients are more involved in treatment selection than those diagnosed with any other type of cancer. This is because with early-stage disease the best choice is based on quality of life considerations, not merely with survival. Therefore only by examining the potential side effects of each treatment option, and comparing it with the other choices, can important distinctions and decisions be made among the alternatives.
Even though patient involvement in the treatment selection process is an absolute requirement, there are potential pitfalls. Clear and objective reasoning may be difficult during a time of shock and grief brought on by the diagnosis of cancer. Strong emotions are also stirred up as one is forced to face the possibility of treatment-related, life-altering side effects that impact sexual, rectal, and urinary function. Patients can be prone to hurried treatment decisions instead of waiting until they have a full understanding of all the information. Despite reassurances, it is hard for patients to escape the lingering fear that unless they act swiftly, the cancer will grow and spread.
Specific Recommendations for Selecting Treatment
- Don’t rush into immediate treatment!
- Obtain thorough and proper staging to determine the likelihood that the cancer has spread to a location in the body distant to the prostate.
- Educate yourself thoroughly about this disease via sources such as the Internet, books, and support groups focused on prostate cancer.
- Whenever possible, seek advice and treatment from doctors who specialize in treating prostate cancer.