If he has it, what are the options for treatment?

"No other disease condition with the incidence of localized prostate  cancer has so many treatment alternatives with so few certainties in the outcome."  Donna L. Berry, PhD, AOCN, FAAN


Few certainties, too many treatment options, where will we begin?  How will we know what to choose and if this is the right option for him?

Options range from Non-Invasive to Surgery..

Least Invasive:

Active Surveillance:
                       monitor PSA every 3 months and re-evaluate
                       repeat biopsy after 1st year, then every 4-5 years

Issues to address:

• frequent visits to the doctor's office
• increased anxiety/worry that levels have increased
• possible need for further treatment options

Why choose this method: 

               most men want to retain their quality of life and avoid side effects as long as possible

More invasive: Radiation Therapies:

External Beam Radiation Therapy:
                     daily targeting of infected tissue with radiation for about 6 weeks

Complications/ Side Effects:

• fatigue
• sexual dysfunction
• irritated bladder (usually short term)
• irritated bowel

Brachytherapy: 

           radiation "seeds" are implanted into infected prostatic tissue, limiting extension to other tissues

Complications/Side Effects:

• irritative bladder
• sexual dysfunction
• need to reduce closeness to pregnant women and infants

Why choose this option?

          men with a more advanced prostate cancer who wish to control

Most invasive: Surgery

Prostatectomy:

                  removal of the prostate, seminal vesicles, and prostatic portion of urethra

Complications/ Side Effects:

• incontinence
• sexual dysfunction

**more practice = fewer complication rates, choose your MD carefully**

Treatment of Stage IV: Bone Metastasis

spread of cancer to areas of the skeleton, commonly: vertebra, ribs, skull and ends of long bones

Hormonal Control/ Orchiectomy

• androgen ablation: removing male hormones through removal of testes
• androgen blockade: add anti-androgen to block adrenal androgens

Complications/ Side Effects:

• hot flashes
• emotional dysfunction
• fatigue
• loss of libido
• impotence

What to consider when discussing treatment options:

• age (with less than 10 years life expectant, active surveillance is recommended)
• quality of life (how important is maintaining a sexual relationship, can you manage fatigue?)
• stage of cancer (advanced stages require more invasive therapies)

*Ask your doctor for a P3P, a questionnaire called Personal Patient Profile for Prostate Cancer

    -helps sort out treatment options by discovering what it most important to you

A Video from Physician right here in Seattle:  What you can expect from your doctor...

UpToDate Comparison of Treatments:

External beam radiation therapy

Effective long-term cancer control with high-dose treatments

Very low risk of urinary incontinence

Available for cure of patients over a wide range of ages and in those with significant comorbidity

Brachytherapy

Cancer control rates appear equal to surgery and EBRT for organ-confined tumors

Quicker than EBRT (single treatment)

Available for cure of patients over a wide range of ages and in those with some comorbidity

Radical prostatectomy

Effective long-term cancer control

Predictions of prognosis can be more precise based on pathologic features in specimen

Pelvic lymph node dissection is possible through the same incision

PSA failure is easy to detect

Active surveillance

Reduces overtreatment

Avoids or postpones treatment-associated complications

Has no effect on work or social activities

References: www.UpToDate.com