Now that prostate cancer is often a treatable disease (like hypertension or diabetes) new problems have surfaced regarding the need for and the timing of treatment. Selecting effective treatment has become complicated by a plethora of treatment options. Here is a brief introduction to the types of therapy available for men with newly-diagnosed or recurrent prostate cancer.
No Treatment – It is now becoming clear that thousands of men undergo aggressive treatment every year for a type of prostate cancer that will never be life-threatening. Active Surveillance, with appropriate monitoring and treatment only administered if the cancer risk increases, is becoming more popular and more accepted for men with low risk prostate cancer. This concept may also be appropriate for men with recurrent prostate cancer when progression is slow.
Local treatment options refer to strategies directed at eradicating the prostate and the cancer it contains. Examples of local treatments are surgery (radical prostatectomy), radioactive seed implantation, external beam radiation therapy, cryotherapy and some newer options. All these “local” treatments, when administered by accomplished experts, provide options that may eliminate the cancer within the prostate with a reasonable degree of consistency. However, there are potential drawbacks. The treatment can cause irreversible side effects to adjoining structures such as nerves that control erections, the urinary track and rectum. Also, the treatment may not cure the cancer. Sometimes the cancer has already spread outside of the prostate. Local treatments may also be options for salvage therapy after initial treatment failure.
Systemic treatment options are designed to stop cancer in the whole body, not just the prostate. These options include hormone therapy, immunotherapy, chemotherapy and a few other treatments. The disadvantages of systemic treatments are that some result in substantial side-effects and the treatments may only suppress the cancer rather than eradicate it. Effective systemic treatments aim to convert prostate cancer into a chronic, non-progressive condition which can be controlled for many years. Fortunately with systemic treatments the side effects are mostly reversible when treatments are discontinued.
Combination options (local plus systemic treatments) are used for selected patients who have a high risk of relapse with local therapy alone. Combination treatment offers the best chance for cure in patients with disease that is at greater risk of being outside the prostate. Combination options are normally reserved for high-risk situations because using two treatments together can cause an accumulation of side effects. Hormonal therapy may be used to shrink the prostate before seed implant or cryotherapy.
Not all forms of prostate cancer are life-threatening. As a result, not all prostate cancer requires treatment. The need for treatment is determined by a man’s “Risk Level.”
Another important consideration is your overall health. You should evaluate your other health risks in making your decisions for treating your prostate cancer. See our paper Who’s At Risk for What?
The transformation of prostate cancer into a treatable disease creates a whole new arena of challenges. Side effects of treatment take on added importance, and the quality of life becomes a priority in cases where survival is not the central issue.
How to evaluate your options?
We suggest you start to understand your risk and options by viewing the content of our pamphlet:
To obtain a more thorough understanding of the issues in staging prostate cancer, read Part 1 of an article by Dr. Mark Scholz “Newly Diagnosed Prostate Cancer: Evaluating the Options”.
You will find more detail on staging, in an article titled “A Strategy of Success in the Treatment of Prostate Cancer”.
Algorithms/nomograms may be valuable tools for evaluating the potential extent of your disease and your risk of recurrence. They are covered under Risk Assessment.
Accurate staging is critically important – If there is significant risk of cancer outside the prostate, advanced imaging with color Doppler ultrasound or Endo-Rectal MRI, may provide important information to help guide your treatment. See Diagnostic Imaging.
Dr. Mark Scholz discussed factors to properly stage prostate cancer and treatment options at the 2007 PCRI Conference. Watch video.
NCCN Clinical Guidelines – requires (free) subscription