Treatment for Ca. Prostate
Treatment plans are influenced by:
- Patient’s age
- Patient's overall condition
Widespread access to PSA testing has lead to detection of many cases of very early stages of prostate cancer. Management of the very early stage prostate cancer remains very controversial and at times challenging.
Surgery
Cure of prostate cancer may be possible with Surgery in the early stages of the disease, when the disease is localized within the prostate gland itself. Surgery for prostate cancer may be difficult and poorly tolerated. It also has some complications, among which impotence and urinary incontinence are the most important ones. In some patients, cystoscopic surgery of prostate, known as Transurethral Prostate Resection may be appropriate.
Radiation
Radiation therapy is a method of choice in individuals who are older and unable to tolerate surgery. Radiation can also cause some complications which may start two to three weeks into the treatment. The course of radiation for prostate cancer varies form six to eight weeks, five days a week.
Brachytherapy is another form of radiating the prostate gland and uses radioactive needles inside the prostate. Following is a list of potential acute and immediate radiation complications:
- Difficulty passing urine
- Burning sensation in pelvic areas
- Increased frequency of urination
- Difficulty starting urine stream
- Diarrhea
- Tiredness
- Increase in flatulence
- Small bowel irritation
- Rectal irritation
- Bladder irritation
Hormonal Treatment
This method of treatment is appropriate for patients who have advanced disease, which cannot be cured by surgery or radiation. Prostate tissue needs testosterone (male sex hormone) for its continuous growth. It will cease from growing in the absence of this hormone. Many hormone treatment modalities use an approach to reduce the production of testosterone or interfere with its effect on the cancer tissue. Following is a list of drugs used to achieve this goal:
Lupron
Zolodex
Casodex
Flutamide
Estrogen (female hormone)
Estrogens were the first drugs used to treat metastatic prostate cancer. They can, however, cause heart problems, as well as blood clot formation in the legs. Change in body contour may occur as a result of Estrogens. Another approach to reduction of Testosterone is removal of testicles, the organs that produce this hormone. Different treatment options have to be discussed with the patients and the input form patients should be taken into consideration.
Chemotherapy
There has been new wave of interest in usage of chemotherapy in advanced and hormone refractory prostate cancer. Mitoxantrone in Combination with Prednisone was approved by FDA as a reasonable treatment option. This regimen has shown efficacy in symptom control and slight prolongation of survival. Other chemotherapy regimens use the following drugs as either single agent or mostly in combination: Taxotere, Taxol, Adriamycin, VP-16 and Cisplatinum.
Follow-Up
Follow-up and evaluation of response to treatment is done by Urologist, Medical Oncologist and Radiation Oncologist. A physical examination, along with blood tests for Testosterone level and PSA, should be done on a frequent basis. The sites of active disease should be followed using CT scans, bone scans, etc.
