From Updated Guidelines for Surviving Prostate Cancer
By E. Roy Berger, M.D., F.A.C.P. and James Lewis Jr., PhD.
Is there a correct way to treat prostate cancer? This is a question that hundreds of thousands of patients and their families are asking. The reason is because there is such enormous disagreement among the various subspecialties that treat the disease.
The answer to the titled question must be, “Yes, I am sure there is a correct way to treat prostate cancer.” However, no one who is currently treating it today can be sure that his or her treatment is the right one. The reason for this is that there has not been a significant number of randomized controlled studies to answer all of the questions related to the various treatment modalities. The current selection of treatment options for patients who have early stage disease include: radical prostatectomy, external beam radiation therapy, brachytherapy (seed implant treatment), cryotherapy, combination hormonal treatment and watchful waiting. In addition, there are a several new drugs that are currently undergoing clinical trials that appear promising to make the treatment of prostate cancer less invasive.
The treatment that is preferred by a given physician very much depends upon his or her training as well as biases that result from their own experiences and interpretation of the medical literature. Urologists are more apt to believe in radical prostatectomy as a curative treatment for early stage prostate cancer. Radiation oncologists frequently believe that radiation therapy, by either external beam, brachytherapy or a combination of both is equivalent to the radical prostatectomy results. Some urologists believe that cryosurgical techniques will be proven to be equally effective as the other two modalities.
A radical prostatectomy, the surgical removal of the prostate, is performed to treat localized prostate cancer. After prostatectomy, the patient's PSA should drop to an undetectable - or virtually undetectable - level. If it does not do so within a month or so after surgery, it is usually assumed that there is residual cancer in the prostatic fossa or elsewhere in the body. Frequently, this cancer is within the area where the prostate gland used to be, and external beam radiation therapy may be helpful. This will often decrease the PSA to an undetectable level.
Approximately 25 to 30 percent of patients whose PSA level is undetectable following radical prostatectomy will have a gradual rise in PSA within 4 or 5 years. This usually means that prostate cancer has recurred. Because no test will indicate with certainty where the recurrence is located, the recommended treatment is often external beam radiation to the area where the prostate used to be. If the physician believes that the recurrent cancer is elsewhere in the body, he or she may recommend external beam radiation, hormonal therapy, or both. The goal with any treatment is to get the PSA level as close to undetectable as possible and to keep it at that level for as long as possible.
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