The Best Treatment for Prostate Cancer

Choosing the best treatment for prostate cancer, can be a difficult and confusing experience.

You have many options to choose from.

Some more invasive than others.

Should you be extra careful and get your prostate removed through surgery, or more conservative with medication or watchful waiting?

Here are some directions you can take for your future prostate cancer treatment.
Prostate Cancer Therapy Recommendations

1. Active Surveillance - Wait and see approach.
2. Prostate surgery (prostatectomy) - Removal of the prostate.
3. Radiation/Brachytherapy.
4. Hormone therapy.
5. Cryotherapy - Freezing the tissue with liquid nitrogen.
6. Chemotherapy.

Active Surveillance

Depending on your form of prostate cancer and treatment, watchful waiting may be recommended. It is a good indication if your cancer is slow growing and fully contained within the prostate. Your doctor will most likely request regular check-ups involving; PSA (Prostate Specific Antigen) tests, digital prostate exams, and a biopsy from time to time if warranted.

Prostate Surgery

Involves complete removal of your prostate. It is generally performed when the cancer is entirely contained within the prostate, is growing at a faster rate, and has not spread. The less conservative your doctor the higher likelihood he will favor surgery over watchful waiting.

Radiation / Brachytherapy

If your cancer has spread or has a high probability of spreading, radiation treatment will more than likely be prescribed. Typically, a finely aimed beam of radiation will be projected towards the prostate, causing death of the cancer and normal cells within and around the prostate.

Hormone Therapy

Historically doctors have prescribed prostate cancer drugs like anti-testosterone therapy to temporarily reduce growth of the prostate cancer.

A newer and more effective therapy is to prescribe anti-estrogen drugs, since estrogen is the main offender for uncontrolled growth of cancerous tissue. Your doctor will usually combine this treatment as a supplement to others.

Cryotherapy

Your doctor may prescribe this an alternative to surgery, especially if you are older or have other medical complications. The procedure involves killing your cancerous tissue within the prostate by freezing it with liquid nitrogen.

Chemotherapy

Chemotherapy is your best treatment for prostate cancer if it has spread or is in it's later stages of growth. It's effects are farther reaching than the other therapies due to it's ability to travel through your blood stream. Unfortunately it will kill both your cancer and normal cells in the process.

It is usually given as either a pill or injection, and generally as a last resort.

From: mens-hormonal-health.com

Best Treatment for Prostate Cancer?

By Maggie Spilner, Fitness, Walking and Yoga Expert

When an older guy has localized prostate cancer, it’s increasingly common for him to be given hormone treatments in the hope that blocking testosterone will shut down further cancer growth. It does seem to be protective for men with localized but more aggressive cancers, when used along with surgery or radiation. But for those with slow growing cancers, hormone therapy shows little or no benefit when compared to no treatment at all, according to a new study conducted at the Robert Wood Johnson Medical School in New Jersey.

In the face of cancer, doctors can feel uneasy doing nothing, so they may view hormone therapy as a safe precaution. But, as this study points out, hormone treatment can have serious side effects, like bone loss, impotence and increasing your risk for diabetes and heart disease.

This study was an extensive examination of the medical records of more than 19,000 prostate cancer patients age 66 or older. That it failed to show any benefit to hormone treatment may help doctors to realize that sometimes, just waiting and watching really is the best treatment.

The Anti-Aging Bottom Line: If you’re over 65 and have discovered you have a slow-growing prostate cancer which has not spread outside the prostate, ask your doctor about watchful waiting, rather than hormone therapy treatment. You may avoid serious health consequences with a “watchful waiting” approach.

What is the best treatment for early stages of prostate cancer?

The best treatments for any cancer are always completely dependent on each individuals specific case and should be discussed with your oncologist. As with almost every solid tissue cancer, surgery is usually the best option for curing the disease. Most prostate cancer patients undergo a radical prostatectomy to remove the entire prostate gland and some tissue around the gland. Lymph nodes around the prostate may also be removed depending on how advanced the disease is. However, because prostate cancer is an unusually slow developing disease, depending on the age and medical condition of the patient, surgery might not be recommended and no treatment may be preformed. Many such men will live out their normal life spans without treatment and without the cancer spreading or causing other problems. Radiation therapy can also be used to treat very early stage prostate cancer or to shrink tumors.

Hormone therapy is another treatment and consists of treatment with drugs such as antiandrogens which lower levels of male hormone androgens which help prostate cells grow. Other drugs, known as luteinizing hormone-releasing hormone (LH-RH) agonists, block the testicles from receiving messages to make testosterone. An orchiectomy (surgery to remove the testicles) might also be performed to reduce testosterone levels in the body. These treatments are used when other treatments are inappropriate or in addition to surgery or radiation in men at high-risk for recurrence of disease or more advanced stages. Chemotherapy may be given in cases in which the cancer has spread to distant organs and hormone therapy is not effective. Neither hormone therapy nor chemotherapy is considered a cure for prostate cancer. Cryotherapy is an emerging therapy where the prostate is frozen within the body, but this treatment has not been perfected and usually results in many complications and side effects.
From WikiAnswers

Prostate Cancer Treatment fact

Deciding on the best treatment for prostate cancer is specific to each patient. That’s why your urologist, primary care physician, and oncologist, will help you decide on the treatment that is best for you. You will want to consider the benefits of each treatment against its possible outcomes, side effects, and risks. The following are some variables that should be considered.

Age
Generally, patients younger than 70 are more likely to fare better with more aggressive treatments, such as surgery. Whereas patients older than 70 may fare better with the less invasive therapies, such as radiation. And those older than 80 are probably the best candidates for watchful waiting, which includes regular prostate-specific antigen (PSA) tests, digital rectal exams (DRE), or other tests whose results indicate whether the cancer has developed enough to require treatment.

Co-existing medical conditions
Because prostate cancer is often slow to progress, many patients with other medical conditions such as heart disease, diabetes, or neurological conditions, may be more likely to suffer complications from those illnesses rather than from the prostate cancer itself.

Prior pelvic radiation
Previous radiation treatments to the pelvic area would limit the use of radiation for the treatment of prostate cancer, because normal neighboring tissue (mainly from the rectum) can receive only a limited amount of cumulative radiation.

Inflammatory bowel disease
Patients with irritable bowel or inflammatory bowel disease do not tolerate radiation treatments well; however, seed implants may be a possible alternative.

Stage and grade of tumor
Doctors will rate the patient’s tumor in a system that measures the tumors spread and aggressiveness. This is called "staging" or "grading" the tumor.

From: emoryhealthcare.org

Which Prostate Cancer Treatment Gives The Best Life Expectancy?

Prostate cancer treatments cover a wide range of approaches that impact life expectancy differently. Believe it or not, no formal clinical studies have been done to determine how best to treat localized prostate cancer. These studies would be extremely difficult to do -- they would take up to 10 years to complete, people would have to be randomly assigned to different treatment groups and the cost would be quite high. So instead, researchers have taken data from the past to compare treatments. This is called a retrospective (or historical) study. Keep in mind that there may be factors unknown to the researchers reviewing medical charts that impact the outcome.

Life Expectancy and Localized Prostate Cancer

Swiss researchers examined the treatment and outcomes of 844 patients diagnosed with localized prostate cancer sometime between 1989 and 1998. Five different types of treatment were applied (the "n" indicates the number of participants):

• prostatectomy (surgical removal of the prostate) n=158
• radiotherapy (radiation treatment) n=205
• watchful waiting (monitoring the cancer) n=378
• hormone therapy n=72
• other treatments n=31

Survival and Lie Expectancy in Localized Prostate Cancer

The researchers looked at the survival rates for each group and found that at five years from diagnosis, the type of treatment made little difference to survival. When the researchers went to 10 years from diagnosis, they did find a difference in survival based on treatment. Overall, 10-year survival was:

• 83% for prostatectomy
• 75% for radiotherapy
• 72% for watchful waiting

Those who had hormone risk had decreased survival rates at 5 years, but this is almost certainly because their cancer was a much more aggressive type when they were diagnosed.

Is Prostatectomy the Best Treatment for Prostate Cancer Then?

You cannot conclude that from this study. What we don't know is why certain people were given the treatment they received. It could be the Swiss doctors have a preference. For example, they might prefer a prosatectomy when the cancer presents a certain way and radiotherapy when it "looks" different. In other words, this study tells us that prostectomy is the most effective OR that doctors tend to send patients with less threatening tumors for prostectomies OR (more likely) a complex combination of both (and throw in some other factors too). Confused yet? Sorry about that. But it is important that you understand the limitations of these studies. Ask your doctor what factors he or she uses to decide on treatment and engage with that discussion.

_Source:

Arnaud Merglen, MD; Franz Schmidlin, MD; Gerald Fioretta, BSc; Helena M. Verkooijen, MD, PhD; Elisabetta Rapiti, MD, MPH; Roberto Zanetti, MD; Raymond Miralbell, MD; Christine Bouchardy, MD, MPH . Short- and Long-term Mortality With Localized Prostate Cancer. Arch Intern Med. 2007;167:1944-1950.

Providing the Best Treatment for Prostate Cancer

By Dr Johann de Bono

10 March 2008 - In the UK approximately 35,000 men are diagnosed with prostate cancer each year, with more than one man dying of this disease per hour.

The growth of prostate cancer cells is driven by the male hormone testosterone. Current treatments for prostate cancer primarily involve hormonal manipulation that stop the generation of testicular hormones. Prostate cancers can, however, continue to grow despite this. Studies now suggest prostate cancer cells can acquire these hormones by other means.

Dr Johann de Bono, Clinical Senior Lecturer and Honorary Consultant in the Section of Medicine at The Institute, and his colleagues are investigating a drug called abiraterone to treat resistant prostate cancer. Dr de Bono explains; “Abiraterone, which was discovered at The Institute, is a chemical inhibitor of the enzyme CYP17 which blocks the generation of the hormones these cancers commonly continue to depend on. Trials of this drug in patients with resistant advanced prostate cancer have produced very promising results. After receiving abiraterone once-daily by mouth, the tumours of more than half the patients have regressed. Patients also reported an improvement in their well-being, decreased pain and use of pain killers. This drug causes tumours to measurably shrink. We now have patients who have been on this drug continuously for more than two years and continuing to have their cancer controlled by this treatment."

"Further evaluation of abiraterone, with American collaborators, is now ongoing with a view to pursuing, in the near future, the studies required for regulatory approval of the drug so that it can ultimately be used routinely in hospitals”, concludes Dr de Bono.

Dr Johann de Bono is leader of The Institute's Prostate Cancer Team in the Section of Medicine

What's the Best Treatment for Prostate Cancer?

By Simeon Margolis, M.D., Ph.D a Yahoo! Health Expert for Nutrition.

Men diagnosed with prostate cancer can now choose from at least four treatment options: Watchful waiting, radical prostatectomy, external beam radiation, and implantation of radioactive "seeds" into the prostate (brachytherapy). But which treatment is best?

For men aged 65 or older with early-stage, moderate prostate cancer, the best approach may be watchful waiting — doing nothing other than repeated examinations and blood PSA tests.

In one major study of over 9,000 older men with low-grade (Gleason score 6 or less), early-stage cancers, only 5 percent died from their disease. Over 80 percent survived for 10 years without any complications, or died from causes unrelated to their cancers.

Watchful waiting, however, is not a good choice for older men with higher grade, early-stage prostate cancer, even if they have a relatively short life expectancy.

The answer is not as clear for younger men newly diagnosed with prostate cancer. One review article published online in The Annals of Internal Medicine analyzed the results of 18 randomized controlled trials and 473 observational studies.

But in the end, this review provided little help in deciding on the best treatment option for these younger men. One reason, according to the authors, is that serious limitations in the evidence made it difficult to compare treatments.

For example, only three of the 18 controlled trials directly compared the effectiveness of three treatments. Of these, one trial found that radical prostatectomy significantly reduced deaths from prostate cancer, whereas another smaller trial found no significant difference between radical prostatectomy and watchful waiting. None of the randomized trials evaluated brachytherapy.

The effectiveness of each treatment, as well as their respective complications, varied widely among the many observational studies, too. And it takes many years after therapy to determine the differences in the rates of cancer spread and survival from prostate cancer.

All of these treatments may lead to complications. The most frequent are impotence and urinary leakage (incontinence). And the studies conflict here, too. While incontinence was about as likely after either radical prostatectomy or external radiation, one large study (the Prostate Cancer Outcomes Study) found incontinence was significantly more common after radical prostatectomy than after external radiation. Impotence occurs frequently after all treatments, but is probably more common after radical prostatectomy.

Given the uncertainties regarding outcome, I advise most men with prostate cancer to consult both a urologist (more likely to recommend radical prostatectomy) and a radiation therapist (more likely to suggest some form of radiation treatment) before deciding on any particular treatment.

In the end, each man's decision must be based not only on the prostate cancer itself but also on the importance he places on the effectiveness of treatment, its convenience, and the likelihood of complications.

Some of my patients have chosen brachytherapy as the most convenient form of treatment. Others elected radical prostatectomy because they couldn't tolerate the notion of allowing a cancerous growth to remain in their bodies.

Surgical Removal Seems Best Treatment For Prostate Cancer

Despite technical refinements in the use of radioactive "seeds" to treat prostate cancer, a study by Johns Hopkins investigators casts doubt on its effectiveness in curing the disease. The radioactive pellets are put into the prostate in a procedure called interstitial radiotherapy.

"This is a wake-up call for physicians and their patients," says Patrick Walsh, M.D., professor of urology and director of the Brady Urological Institute and lead author of the study, published in the June issue of Urology. "Because studies from 20 years ago showed that interstitial radiotherapy often failed to completely eliminate local disease, we set out to determine whether recent refinements in seed placement improved the outcome and to develop a gold standard by which radiotherapy should be judged."

Using low levels of prostate specific antigen (PSA) as an end point, Walsh's group compared the outcomes in 76 men whose prostates were surgically removed at Hopkins with the published outcomes of 122 men who were treated with radioactive implants and no external radiation at the Northwest Institute in Seattle. PSA is a protein produced by the prostate. Increases in blood levels of PSA generally reflect either benign prostate enlargement or cancer.

The patients from Hopkins were carefully matched to the radiotherapy patients at Northwest Institute to ensure their PSA levels and Gleason scores before treatment were similar. The Gleason score is a measure on a scale of two to 10 of how aggressive prostate cancer appears under the microscope. The higher the score, the more aggressive the cancer is assumed to be.

The study showed that seven years after being treated, 98 percent of surgery patients had PSA levels that were undetectable (less than 0.2), while only 79 percent of men who underwent radiotherapy had PSA levels less than 0.5.

Walsh says results obtained with surgery should be used as the gold standard by which radiotherapy is judged. "That gold standard should be very low, or undetectable levels of PSA," he says. "The failure of interstitial seed therapy to achieve this goal questions whether it is eliminating the tumor adequately."

In an editorial accompanying Walsh's paper, Anthony D'Amico, M.D., Ph.D., of Harvard Medical School, said: "Although no definitive conclusions can be reached using nonrandomized retrospective data, this study provides the basis on which to design a prospective randomized clinical trail that could definitively compare PSA failure-free, cause-specific and overall survival...among these two treatment modalities...."

Walsh developed the anatomic approach to surgical removal of the prostate. This procedure, also called the nerve-sparing operation, preserves nerves that control sexual potency and bladder control.

Other authors of the paper include Thomas J. Polascik, Charles R. Pound and Theodore L. DeWeese.