Although it moves slowly, prostate cancer does progress over time. While older men with other health concerns might not want to seek curative treatment, "it's very appropriate" for younger, healthier men. And treatments have improved greatly.
That's the view of Dr. Richard Labasky, urologist at Alta View Hospital, and Dr. George Middleton, a urologist at Cottonwood Hospital. The two will be featured on today's Deseret Morning News/Intermountain Health Care Hotline. From 10 a.m. to noon, they'll take phoned-in questions about prostate cancer. The toll-free number is 1-800-925-8177.
There are four types of treatment, starting with "observation," said Labasky. It's a choice particularly for older men who are not in good health, or in cases where biopsy shows a very minimal amount of cancer. With that choice, the doctor monitors prostate-specific antigen levels and symptoms. If the disease progresses, "perhaps at that time we initiate treatment."
Because testosterone influences the growth of the prostate, removing the hormone shuts it down. That can be done surgically, removing the testes, or with medications that turn off production of testosterone.
"The people who go in that direction are older and know they will not be cured. Or they maybe had radiation or surgery and it failed so there's evidence of disease spread," he said.
Because of earlier detection, that's less common as an early option, but it's "a good and appropriate therapy that has worked for many years," Labasky said. "The drawback for that is it takes away the effects of the hormone," resulting in fatigue, hot flashes, weight change and other side effects. Because of loss of sexual function and libido, "it is not an attractive option for younger men."
The most active treatment options revolve around surgery and radiation, both aiming for a cure.
With surgery, the prostate is removed entirely, often along with nearby lymph nodes. It is in many circumstances curative. Healthy patients often choose surgery, though it's not usually appropriate for those in their late 70s and beyond. There are minimal risks of bleeding and infection, and older patients are apt to die with, not of, prostate cancer anyway because of its typically slow progression, the two urologists agree.
Surgery typically means a couple of days in the hospital.
There may be long-term results of surgery, including loss of urinary control or sexual function. Most of the time, neither occurs. In both cases, Middleton said, treatments usually resolve them, so many men, especially younger ones, opt for surgery.
Radiation therapy is the other curative treatment, done either with external-beam radiation therapy that shoots through the body or with radioactive seeds implanted in the prostate. External-beam radiation is more precise than in the past, and higher doses of radiation can be used.
Implanting radioactive seeds is called brachytherapy, and the result is a high-dose, concentrated application of radiation, Labasky said. It's a technique that made a big splash, then initially failed to live up to its promise, but it's back and much improved.
The radiation fades over the course of several weeks. The seeds, each the size of the tip of a lead pencil, remain in the prostate. And though there may be from several dozen to a hundred, they are harmless and don't create problems.
Of the two radiation forms, more side effects are possible with external beam, particularly in the bladder and rectum. With improvements in precision, those side effects are diminishing, Labasky said.
Cure rate, regardless of treatment choice, depends on the grade and stage of cancer.
"If it's lower grade, less aggressive and confined, the cure rate is extremely high," Labasky said, but he warned that the cancer can still progress beyond that time if small amounts of cancer escaped undetected. "We need to be watching carefully."
E-mail: lois@desnews.com