Prostate Cancer

Treatment

Many men whose prostate cancer is slow growing and found at an early stage may not need treatment. Also, prostate cancer treatment may not be advised for older men or men with other serious medical problems. For these men, the possible side effects and the risks of the prostate cancer treatment may outweigh the possible benefits of treatment; instead, the doctor may suggest "watchful waiting"--following the patient closely and treating the patient later for symptoms that may arise. Researchers are studying men with early stage prostate cancer to determine when and in whom prostate cancer treatment may be necessary and effective.

Methods of Prostate Cancer Treatment

Treatment for prostate cancer may involve surgery, radiation therapy, or hormone therapy. Sometimes, patients receive a combination of these treatment options. In addition, doctors are studying other methods of treatment to find out whether they are effective against this disease.

Surgery is one of the most common treatments for the early stages of prostate cancer. Surgery to remove the entire prostate is called radical prostatectomy. It is done in one of two ways. In retropubic prostatectomy, the prostate and nearby lymph nodes are removed through an incision in the abdomen. In perineal prostatectomy, the prostate is removed through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen. If the pathologist finds cancer cells in the lymph nodes, it may mean that the disease has spread to other parts of the body.

Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill cancer cells. Like surgery, radiation therapy is local therapy; it can affect cancer cells only in the treated area. In early stage prostate cancer, radiation can be used instead of surgery, or it may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages, it may be given to relieve pain or other problems.

Radiation may be directed at the body by a machine (external radiation), or it may come from tiny radioactive seeds placed inside or near the tumor (internal or implant radiation, or brachytherapy). Men who receive radioactive seeds alone usually have small tumors. Some men with prostate cancer receive both kinds of radiation therapy.

For external radiation therapy, patients go to the hospital or clinic, usually 5 days a week for several weeks. Patients may stay in the hospital for a short time for implant radiation.

Hormone therapy prevents the prostate cancer cells from getting the male hormones they need to grow. When a man undergoes hormone therapy, the level of male hormones is decreased. This drop in hormone level can affect all prostate cancer cells, even if they have spread to other parts of the body. For this reason, hormone therapy is called systemic therapy.

There are several forms of hormone therapy. One is surgery to remove the testicles. This operation, called orchiectomy, eliminates the main source of male hormones.

The use of luteinizing hormone-releasing hormone (LHRH) agonist is another type of hormone therapy. LHRH agonists prevent the testicles from producing testosterone.

In another form of hormone therapy, patients take the female hormone estrogen to stop the testicles from producing testosterone.

After orchiectomy or treatment with an LHRH agonist or estrogen, the body no longer gets testosterone from the testicles. However, the adrenal glands still produce small amounts of male hormones. Sometimes, the patient is also given an antiandrogen, a drug that blocks the effect of any remaining male hormones. This combination of treatment is known as a total androgen blockade.

Prostate cancer that has spread to other parts of the body usually can be controlled with hormone therapy for a period of time, often several years. Eventually, however, most prostate cancers are able to grow with very little or no male hormones. When this happens, hormone therapy is no longer effective, and the doctor may suggest other forms of prostate cancer treatment that are under study.

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