Prostate cancer is the number one cancer diagnosed in men in the United States. It is the number two cause of cancer deaths in men in the United States behind lung cancer. Men who are at highest risk to develop prostate cancer are those with a primary relative with it. These men have twice the risk than the average male population. Those with two affected primary relatives have five times the risk of the average male population. African-American men have approximately a 1 1/2 time higher risk of developing prostate cancer than Caucasian men.
It is known that 80% of men over 80 years old will have evidence of microscopic prostate cancer based on autopsy studies. This finding has created a lot of confusion regarding the proper treatment for prostate cancer as many critics of treatment for prostate cancer have pointed out that many men die with prostate cancer rather than from it. However, as earlier stated, prostate cancer is the number two killing cancer in men behind lung cancer. There's a new prostate cancer diagnosed in the United States every 3 minutes and a death from it every 15 minutes. Thus, there seems to be two different types of prostate cancer. Numerous studies have shown that those prostate cancers that are picked up on physical examination from digital rectal examinations and PSA screening tend to be much larger and potentially dangerous cancers than those that are picked up on autopsy studies. Even with clinically detected prostate cancers, the urologist is able to predict which cancers are likely to be a threat to a patient's life in the long run. This is based on such factors as the age and general health of the patient and how advanced the cancer is at the time of diagnosis. Thus, for example, some patients may be advised to have complete surgical removal of the prostate (radical prostatectomy); while others may be advised to simply keep "an eye on things" (watchful waiting). The following summarizes a review of prostate cancer treatment.
1. Radical Prostatectomy. Radical prostatectomy can be done in either the retropubic approach (radical retropubic prostatectomy) or through a perineal approach (radical perineal prostatectomy). This results in complete removal of the prostate and seminal vesicles. Since the prostate is located in between the neck of the bladder and the urinary sphincter muscle, the main potential side effect of this surgery is that of urinary incontinence. Using modern surgical techniques, these risks are very low. The other main potential risk of surgery is impotence. The nerves that are involved in erections run right along side of the prostate. A nerve sparing radical prostatectomy can be performed in an attempt to spare these nerves and thus preserve potency after the operation. However, not all patients are candidates for this type of surgery because if the tumor is in the vicinity of these nerves, the tumor may be left behind. Even if potency does not return following surgery, there are now a number of ways to restore it. In those patients with potency after surgery, orgasms are attainable but they will be dry since the seminal vesicles have been surgically removed. Hospitalization varies from two to three days and patients are sent home with an indwelling Foley catheter which is removed two weeks later.
2. Radiation therapy
a). External beam radiation therapy. This involves receiving radiation therapy to the prostate five days a week for six weeks at a radiation oncology center. Using modern radiation therapy techniques, most of the side effects tend to be transient. These mainly consist of urinary and intestinal symptoms which tend to improve after radiation therapy is over. There are still risks of incontinence and impotence, although they are low. Patients who have had radical prostatectomy and subsequently develop evidence of recurrent cancer can receive subsequent radiation therapy to try to eliminate this recurrent disease with minimal risk of side effects. On the other hand, patients who have been treated with radiation therapy for their prostate cancer are at much higher risk for potential side effects if they choose to have a radical prostatectomy for recurrent disease. Occasionally, radiation changes in the prostate make radical prostatectomy even impossible to perform.
b). Radioactive seed placement. While this form of treatment was popular in the past, and subsequently abandoned because of poor results, it has again resurfaced as a legitimate form of treatment. The use of ultrasound has made seed placement in the prostate more accurate. Thus, instead of the radiation being received from an external source daily over a 6 week period of time, the radioactive seeds provide an internal source of radiation decaying over a period of a month. Different types of radiation seeds are placed depending on the extent and grade of the cancer. Sometimes two treatments may be required. Long term results for radioactive seed placement is not yet available.
c). Hi dose radiation (HDR) therapy. This form of treatment may be performed in conjunction with external beam radiation. Radioactive wires/needles are placed temporarily through the perineum (area between the scrotum and anus) using ultrasound guidance. This involves a 23-hour stay in the hospital
3. Cryosurgery. This involves freezing the prostate also under ultrasound guidance. Our group has one of the most extensive experiences in cryosurgery in the country. However, because most insurance companies do not cover this form of treatment, it is not performed as frequently as in the past. As with the other forms of treatments, potential side effects also include incontinence and impotence.
4. Hormonal therapy. Prostate cancer is dependent on the male hormone testosterone in order for it to grow. By depleting the body of testosterone, prostate cancer will significantly shrink and be well controlled for a long period of time. This can be accomplished through shots as well as through removal of the testicles. The effectiveness and side effects of the treatment are the same for both the medical or surgical approach. These include a loss of interest in sex as well as hot flashes.
5. Watchful waiting. This is recommended for men who are believed to have clinically insignificant cancers that are unlikely to have an impact during their life time. This involves periodic visits to the urologist, coupled with PSA testing to be sure that the prostate cancer continues to remain clinically insignificant.
Also, for more information see Minimizing Prostate Cancer Through Nutrition