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The best treatment for prostate cancer?
Asked about 1 year ago - Fargo, ND
I’ve had three friends with prostate cancer in the past year, and they all got different treatment. One had his whole prostate removed, another had radiation (brachytherapy?), and the third said he’s not having any treatment unless his PSA goes up. They’re all about the same age, so why is treatment so different? Is there one best treatment?
Doctor answers (1)
As I'm sure you've guessed, there is no single best treatment for everyone. The best treatment depends upon you and your physician. As a family physician and geriatrician who deals with this situation frequently, you'll often hear the urologist recommending surgery and the radiation oncologist recommending brachytherapy or some focused external beam radiation. However, as you've noted, there is even a movement towards watchful waiting or active surveillance, supported by recent research. In fact, a study was published yesterday (March 31, 2011) concluding that screening made no difference in all-cause mortality (death rates).
For those older patients who are otherwise low risk, have low-grade, localized disease, regular assessment of one's PSA w/scheduled repeat biopsy to monitor its aggressiveness (as measured by Gleason score), is an option. However, you must be able to deal with the uncertainty. Often, robotic laparoscopic, nerve sparing radical prostatectomy is recommended for younger patients with a similar presentation. However, compared to those who elect active surveillance, the risk of incontinence & erectile dysfunction increases dramatically. Interestingly, studies looking at side effect profiles of surgery vs radiation demonstrate no difference in the long term. And of course, quite a bit depends upon the skill of the surgeon.
However, all bets are off if you have aggressive disease that's spread. In that case, I defer to the oncologists, radiation oncologists & urologists. Just know that some recent data has come out that purposefully lowering one's testosterone as a method for treating prostate cancer can actually increase one's risk for becoming obese & developing diabetes & heart disease, to such an extent that one's all-cause mortality is actually greater. Of course if you have bone pain from spread of prostate cancer, then lowering one's testosterone will do wonders for controlling your pain.
What's amazed me the most is a recent study that found no further progression in prostate cancer for a small select number of men w/low grade, localized disease who received testosterone supplementation because they were symptomatic of hypogonadism. Over the last several years, there have been several studies looking at offering testosterone supplementation to men after their surgery (it makes no sense to do so in those who you are actively lowering their testosterone).
To answer your question as to why treatment is so different? Whenever we don't have any data as to the best course of action, you'll always see multiple options. Don't forget that everything looks like a nail to those who hold a hammer in their hand. As a family physician & geriatrician, I don't have a dog in this race. I just want what's best for you, my patient. I'd always suggest seeing all three specialists (urologist, medical oncologist, and radiation oncologist) before making any decision.
For those older patients who are otherwise low risk, have low-grade, localized disease, regular assessment of one's PSA w/scheduled repeat biopsy to monitor its aggressiveness (as measured by Gleason score), is an option. However, you must be able to deal with the uncertainty. Often, robotic laparoscopic, nerve sparing radical prostatectomy is recommended for younger patients with a similar presentation. However, compared to those who elect active surveillance, the risk of incontinence & erectile dysfunction increases dramatically. Interestingly, studies looking at side effect profiles of surgery vs radiation demonstrate no difference in the long term. And of course, quite a bit depends upon the skill of the surgeon.
However, all bets are off if you have aggressive disease that's spread. In that case, I defer to the oncologists, radiation oncologists & urologists. Just know that some recent data has come out that purposefully lowering one's testosterone as a method for treating prostate cancer can actually increase one's risk for becoming obese & developing diabetes & heart disease, to such an extent that one's all-cause mortality is actually greater. Of course if you have bone pain from spread of prostate cancer, then lowering one's testosterone will do wonders for controlling your pain.
What's amazed me the most is a recent study that found no further progression in prostate cancer for a small select number of men w/low grade, localized disease who received testosterone supplementation because they were symptomatic of hypogonadism. Over the last several years, there have been several studies looking at offering testosterone supplementation to men after their surgery (it makes no sense to do so in those who you are actively lowering their testosterone).
To answer your question as to why treatment is so different? Whenever we don't have any data as to the best course of action, you'll always see multiple options. Don't forget that everything looks like a nail to those who hold a hammer in their hand. As a family physician & geriatrician, I don't have a dog in this race. I just want what's best for you, my patient. I'd always suggest seeing all three specialists (urologist, medical oncologist, and radiation oncologist) before making any decision.
