With almost 200,000 men diagnosed each year, prostate cancer is the most common cancer in American men. And with an annual toll of about 40,000, it's among the deadliest. • But with early detection and new treatment options, the future is looking better than ever for men who receive this diagnosis. Here are some of the questions I've heard most often about treating prostate cancer.
What's the latest in prostate cancer treatments?
There is no one treatment that is best for all patients, so it's important to do your homework.
The tried-and-true treatments of surgery, radiation therapy and brachytherapy (seed implants) are still the ones I recommend, since they have at least 15 years of results behind them.
There are newer treatments, with less than five years follow-up that have their advocates. They are: Cyberknife, HIFU (High-Intensity Focused Ultrasound), and localized cryosurgery.
Every cancer patient has different risk factors, life situations and emotional reactions, all of which must be considered.
Tell me more about the traditional treatments.
• Watchful waiting: For low-risk, small cancers in patients who are comfortable with having multiple biopsies and PSAs to track the cancer.
• Radical prostatectomy. Recommended on its own for low-risk groups; possibly combined with radiation and/or chemotherapy in high risk patients. The entire prostate, seminal vesicles and lymph nodes are removed, preserving the nerves to the penis. It can be done with an open incision or with less invasive laparoscopic or robotic surgery.
Surgery has an increased risk of incontinence and erectile dysfunction compared with other therapies, but these are reduced significantly with the latest techniques and an experienced surgeon. It's the only treatment that lets us know the disease stage precisely.
• Radiation therapy is less invasive, but takes visits of 30 minutes, five times a week for seven weeks. The beam is highly focused to the tumor so exposure to surrounding tissue is minimal. More rectal, bladder and bowel irritation occur than with surgery, but are usually short-lived. The risk of ED may be less.
• Brachytherapy is the implantation of radioactive iodine or palladium seeds, the size of rice grains, into the prostate. It is a single outpatient procedure. A catheter is kept in overnight and then the patient is back to normal activities in a few days. The radiation dose is low and confined to the prostate with little rectal or bladder effects. More urinary frequency and burning is experienced, but this usually is short-lived. There should be less ED and no incontinence unless the patient had previous prostate surgery.
How do I know how aggressive my prostate cancer is?
There is no definitive test to tell you if your tumor is aggressive or harmless. But we do have some reasonable indicators. First, know your Gleason score (a measure of how the cancer cells look under the microscope).
Generally, a Gleason of 6 is slow growing, A score of 7 and above is more worrisome. Know how many biopsies your doctor obtained (12 should be the minimum; fewer, and cancer cells can be missed), and know how fast your PSA (prostate-specific antigen) has been changing from year to year (the faster it has been rising the quicker you need treatment). PSA and the Gleason score determine your risk group.
That's a lot to handle all at once.
Take your time, get the facts, make the decision that's most comfortable for you, then move forward with confidence. This is not an emergency decision.
What other questions should I be asking?
If you are considering surgery, ask your doctor how many procedures he has done, and what his results are. Ask about complications.
Seek second opinions from other surgeons, medical oncologists and radiation therapists. (Be aware, though, that doctors in each specialty usually think their treatment is the best.) Ask for names of patients willing to talk with you about their treatments. Study your condition on the Internet. Discuss the options carefully with friends and family, especially your significant other.
What are the cure rates of the various options?
That depends on the patient's risk group and the doctor's experience. Your doctor can tell you what his or her own cure rates are. General rates, calculated from large medical centers across the country, are excellent for low-risk patients who have surgery, radiation or seed implants, around 95 percent.
Cure rates for those at intermediate risk are 65 to 80 percent, but are improved with combination therapies. Patients at high risk can have cure rates of 55 to 75 percent, depending on whether the cancer has spread beyond the prostate itself.
What if my treatment fails?
There are now many options for treatment failures — radiation therapy after surgery; cryosurgery after radiation therapy or seeds; salvage radical prostatectomy by experts. Hormone therapy is often used successfully for years.
Newer forms of chemotherapies are also in use and more are in development.
Dr. Sharkey is a prostate cancer educational consultant in Palm Harbor and was in full-time urological practice for 40 years. Contact him at (727) 786-4531 or at firstname.lastname@example.org.