When a man is newly diagnosed with prostate cancer there are a few options you can choose from in terms of treatment
Which factors should be considered before deciding on treatment?
The majority of men are diagnosed with what we call localized prostate cancer meaning that cancer has not spread beyond the gland.
While some of them might live forever and never die of cancer even without treatments
The other will have the much more aggressive disease and will need to be more aggressive treatment up front.
In order to stratify the patient and different risk categories to guide them through treatment.
We have used clinical parameters such as the serum PSA, the Gleason score which is found under biopsy results, as well as the extent clinically through rectal exam and imaging to building prognostications system that will guide our treatment.
Based on these three factors we have pieces with low risk of disease progression intermediate and high-risk.
For patients with very low-risk Active surveillance is actually a recommended modality meaning are close follow-up serial push X and repeat biopsies and treatment at the time of disease progression.
Patients who have the low-risk disease can choose in selected cases between active surveillance or treatment with radiation or Radical Prostatectomy.
Patients with intermediate great disease probably should not observe and the silent treatment with either radiation or surgery and if they choose to undergo radiation therapy should be treated with six months of hormone deprivation therapy.
High-risk patient meaning those who are at the highest risk for progression and the task to seize up should either under undergo prostatectomy or if they choose to have radiation therapy will combine this with two to three years of androgen deprivation.
How to choose between surgery or radiation will depend on the patient profile?
If the patient is not good a good surgical candidate because of other core morbid conditions he has such as heart disease diabetes or advanced age then treatment is likely to be radiation with or without hormone deprivation.
A younger fifth patient for example in his fifties was no other medical issues and a very aggressive disease might probably benefit more from up-front surgery.
The side effects Associated with radiation and surgery are explained by the technique.
With surgery, the main goal for the quality of life is to try to preserve the nerve bundles that mediates sexual function.
So for the surgeon who performs this procedure, the question is can I preserve the nerve bundle safely meaning without leaving any disease behind.
This should be discussed with the patient prior to the procedure.
Based on the risk level the search you will also entail removal of lymph nodes in the pelvis which might cause some problems down the road such as edema.
If the so-called urinary sphincter muscle is affected during the surgery the patient might suffer from incontinence after the surgery.
Most of these side effects will improve over time by about two years after surgery depending on what study will look at thirty to fifty percent of patients will have some decrease of these functions although they are not very severe.
It’s important to know that for example sexual dysfunction can be treated with implants and medication
So a counseling the patient is very important to know that we are able to control most of the side effects
Patients who elect to undergo radiation will have more acute side effects such as irritable bowel that is in the radiation field and is a manifested by up frequent bowel movements, urgency and sometimes also a rectal bleeding but again these are acute side effects and most of them resolve over the first one to two years.
The urinary symptoms that patients who undergo radiation experience are explained by what we call the radiation cystitis
So it’s more the irritation of the bladder rather than our interaction with the sphincter muscle
So again they will have emergency meaning they have to go to the bathroom a lot have some burning sensation but this over time will improve as well
Sexual dysfunction, on the other hand, is a side effect there will develop over time and the increased typically over the first one or two years in patients who undergo radiation
But if you look at two years in most studies there is not a major difference in terms of long-term side effects of surgery of this radiation in the majority of men.
So other medical problems as mentioned earlier will help guide the decision-making.
What if there was a test that could determine how aggressive prostate cancer is
Genomic Health is developing a new test to do just that by reviewing the underlying biology of the tumor
and using genes from multiple biologic pathways.
The test can predict the aggressiveness of prostate cancer when diagnosed allowing a man to make more informed treatment decisions with confidence taking care of himself with more information and greater peace of mind.