Prostate Cancer Treatment

The success of cancer therapy depends on early detection and radical removal of all the cancer cells. With prostate cancer this was difficult to achieve prior to the invention of the PSA test, as there was no way to diagnose stage A prostate cancer. With the PSA test it is now possible to detect cancer of the prostate earlier and with the introduction of the selective radical prostatectomy excellent cure rates of 15 and 20 year survival rates are achieved, which for practical purposes can be considered a cure.

In the past with a radical prostatectomy the nerves supplying impulses to the penis for erection were severed.

However, now the urologist can explain that with the help of new technology using an operating microscope, in most cases the selectiveradical prostatectomy can preserve penis erection after the surgical procedure is done. However, the urologist can only do what is technically possible and unfortunately there will be some cases where cancer tissue has overgrown the nerve supply and it has to be removed. In such a case in the interest of the man's survival, the nerve may have to be severed as the cancer is removed. Overall the statistics show that about 85% of stage A and B prostate cancer patients can have a successful selective radical prostatectomy, in other words only 15% lose their potency.  

However, for stage C and D where the cancer has broken through the tough prostate capsule surgery gives no survival advantage versus the radiotherapy approach. Therefore only external radiotherapy is available as an option to marginally improve survival.  

In breast cancer many cancer types have estrogen receptors and the estrogen blocking agent tamoxifen is used to block cancer growth. Hormone manipulation is also effective in the treatment of prostate cancer where the cancer cells often have testosterone receptors on their surface. Growth is significantly reduced when testosterone is removed from the system. In the past this was achieved by castration (=bilateral orchiectomy = removal of both testicles). With the introduction of an analogue to the hypothalamic hormone called " luteinizing hormone-releasing hormone" this surgery, which many men were afraid of, is no longer necessary as it is as effective as a bilateral orchiectomy.

However, there are still traces of testosterone in the system from the adrenal gland metabolism. As Ref.6 points out this can be treated with antiandrogenic medication such as bicalutamide ( brand name: Casodex). In a stage C patient the hormone manipulation in that manner will lead to a survival advantage of 2 years when the treatment is compared to a control group treated with radiotherapy alone.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

The following references were used apart from my own clinical experience:

1. Cancer: Principles &Practice of Oncology, 4th edition, by V.T. De Vita,Jr.,et. al J.B. LippincottCo.,Philadelphia, 1993.Vol.1: Chapter on Prostate cancer.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999.Chapter 233, p.1918-1919.

3. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T.DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on prostate cancer.

4. A Waghray et al. Cancer Res 2001 May 15;61(10):4283-4286.

5. BM Fisch et al. Urology 2001 May;57(5):955-959.

6. CC Parker et al. BJU Int 2001 May;87(7):629-637.

7. B Aschhoff Drugs Exp Clin Res 2000;26(5-6):249-252.

8. Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

9. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc

Last Modified: Jan. 19, 2008