Treatment Alternatives for Prostate Cancer
With Dr. Michael T. Von Rueden, St Mary's Medical Clinic
According to current statistics, one in four men will have prostate cancer at age 50. At age 80 it's one in two men. As a man ages, his risk of prostate cancer increases.
For males with prostate cancer, choosing a treatment option may not be easy. Available alternatives such as surgery, external beam radiation therapy, radioactive seed implants, hormone therapy, or watchful waiting, may be possible choices, depending on circumstances. For that reason, it's important that those with the disease learn all they can about it before making that decision with their doctor.
That's the opinion of Dr. Michael T. Von Rueden, a family practice physician with St. Mary's Medical Clinic in West Allis.
"It's difficult to determine the appropriate treatment because of all of the different factors that are involved in prostate cancer--the patient's age, if it has spread to areas beyond the prostate gland, how aggressive it is," he said. "It's usually slow growing, and if you came down with it at age 80 it's likely you'll die from something else. That's where watchful waiting might be indicated. There's a gray zone where you start balancing how long you're expected to live with the likelihood of dying from the prostate cancer."
The good news is that if it's detected early, when it's still confined to the prostate gland, the patient has a better chance of successful treatment with minimal or short-term side effects. Successful treatment of cancer that has spread beyond the prostate gland is more difficult. But treatments exist that can help control the cancer.
Surgical removal of the prostate gland, called a radical prostatectomy, is an option to treat cancer that's confined to the prostate gland, according to Dr. Von Rueden. During this procedure, surgeons remove the prostate and local lymph nodes while trying to spare the muscles and nerves that control urination and sexual function."Side effects, like erectile dysfunction, can occur," he advised, "but that happens to a smaller percent of patients."
When one has prostate cancer, androgens or male sex hormones can stimulate the growth of cancer cells; the main type of androgen is testosterone. "So hormone therapy uses drugs to try to stop your body from producing testosterone," said Dr. Von Rueden. "It's essentially a chemical castration."
Men with advanced prostate cancer often choose this form of treatment to help slow the growth of the cancer.
"Because most testosterone is produced in the testicles, surgical removal of the testicles (castration) also can be an effective form of therapy, especially for advanced prostate cancer," he said.
Another treatment option is external beam radiation therapy. Here, high powered X-rays are used to kill the cancer. This type of radiation is effective at destroying cancerous cells, but it can also damage adjacent healthy tissue. Treatments are generally given five days a week for about seven or eight weeks.
Radiation brachytherapy is another form of radiation therapy, according to Dr. Von Rueden. This technique, which has grown in popularity in recent years, involves implanting radioactive seeds into the prostate gland. The seeds deliver a higher dose of radiation than do external beams. "The goal is to shrink and destroy the cancer without side effects," he explains. The seeds contain isotopes of either iodine and palladium and don't have to be removed after they stop emitting radiation after about one year.
"It's important to stress that men need to see their doctors regularly and get screened for prostate cancer," he said. "In my practice we've caught it early in many of my patients. They've had therapy of one kind of another, and are now fine. It's wonderful how a relatively simple digital rectal exam or a PSA test can effectively find early prostate cancer and pave the way to successful treatments."
