Quarterly Update
Chapter 21
Medical Highlight: Cancer of the Prostate
Cancer of the prostate is the most common cancer after skin cancer in men living in the United States. In 2005 it is expected to strike more than 230,000 men and kill around 30,000. Treatments for early stage disease include surgery, radiation, or watchful waiting. Trying to determine which treatment is best can be difficult especially for men with early stage disease.
In the Journal of the American Medical Association (Vol. 293, No.17:2095-2101) a study was published that suggested some men can safely skip treatment, a strategy known as watchful waiting. Some prostate cancers grow very slowly and never cause problems. Treating these cancers might not be necessary and treatment could also lead to side effects such as impotence and incontinence. Other prostate cancers are aggressive and deadly. In these cases the benefits of treatment outweigh the risks of side effects.
There is no ironclad way to tell for certain which type of cancer a man has but there are some biological clues such as prostate-specific antigen (PSA) levels and the Gleason score, a measure of how abnormal and potentially aggressive the cancer cells are. The Gleason score examines cells that are biopsied and gives them a score from 1-10. If the cancer cells appear more normal a score of 1 is assigned. On the other hand if the cells in question appear irregular and very differentiated from the normal cells they may be assigned a score of 5 or higher. Men with low marks in both these evaluations may have slow growing cancers and be candidates for watchful waiting.
There are different types of treatment for prostate cancer. Four types of standard treatment are:
• Watchful waiting closely monitors a patient’s condition without any treatment until symptoms appear or change.
• Surgery
a. Radical prostatectomy includes the removal of the prostate and surrounding tissue, along with nearby lymph nodes.
b. Transurethral prostatectomy removes tissue from the prostate using a cystoscope. This procedure is sometimes used before other cancer treatment is given.
• Radiation therapy uses high energy X-rays or other types of radiation to kill cancer cells.
• Hormone therapy is a treatment that removes hormones, blocks their action, and stops cancer cells from growing. In other words, luteinizing hormone-releasing hormone agonists prevent the testicles from producing testosterone which may accelerate the growth of cancerous tissue.
Other types of treatment being tested in clinical trials include:
• Cryosurgery is a treatment that uses an instrument to freeze and destroy cancer cells.
• Chemotherapy is the use of drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.
• Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made in the body or in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.
• High-intensity focused ultrasound is a treatment that uses ultrasound to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves.
Reference
National Cancer Institute. (2005). Treatment option overview. Retrieved June 4, 2005
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