Treatment Options for Prostate Cancer

Choosing the best treatment for your prostate cancer means doing your homework and building a team of experts. Unfortunately, many men never go beyond the advice of the first doctor to diagnose their condition. Get second opinions (most insurance cover this), get third opinions. Get you pathology slides re-read by an expert so you and the doctors know what you're dealing with.

Looks at six different options that many men must evaluate. A good starting point but weighted toward surgery. Not enough details about different types of brachytherapy and external beam therapy (e.g. proton beam). By Karen Springen and Jerry Adler NEWSWEEK

Prostate Cancer Treatment Guidelines For Patients(July, 1999) Still an essential starting point . Gives information on how prostate cancer is treated at leading US cancer centers.

Available in Spanish:: Cáncer de la próstata - Guías de la NCCN para el tratamiento de los pacientes.

The National Comprehensive Cancer Network (NCCN) wrote these guidelines for cancer specialists, then laid them out for the public with help from the American Cancer Society (ACS). You can download an Adobe Acrobat file or get the booklet by calling (ACS) at 1-800-2435 or (NCCN) 1-800-909-NCCN

Manny Hamelburg, 58 Diagnosis: Prostate cancer, Oct. 27, 1987 Treatment: Radiation Diagnosis: Prostate cancer metastasized to spine and hip, July 24, 1992 Treatment: Combined hormone therapy and chemotherapy (Suramin) Massachussetts General Hospital "Wall of Hope."

PROSCAR (Finasteride) for Prevention?

Does Finasteride Prevent Prostate Cancer? New England Journal of Medicine July 17, 2003.

Watchful Waiting?

The Waiting's Watchful, but is it Rational? Barry Tepperman, M.D. "Recommending a management for early stage prostate cancer involves selecting among a number of different options. Arguments can be made in favor of aggressive local treatments and hormonal therapies to suppress disease activity. The literature even suggests that some patients would do just as well if they were treated 'expectantly' - watched, with treatment delayed, until something else happened.... Under what circumstances could a rational physician recommend - or a thinking patient demand - that nothing specific be done?"

Surgery

Minimally Invasive Surgery for Prostate Cancer (Mass. General Hospital, Boston is one center that offers this now)

Some recollections from patients about their surgery. Be aware these date from some years ago and techniques may have improved.

Prostate Cancer Story: "CURED? Neoadjuvant CHT and RP A 15-Month Prostate-Cancer Anecdote"by Pete Wilson (1995). At U of Penn's Oncolink.

"I will Read Your Words Too" by Gary Elgort. Diagnosed with prostate cancer at age 41, Gary tells his story through treatment and early recovery.

Hormonal Therapy

Hormonal Therapy For Prostate Cancer: What, How, When, and Why US TOO International Incorporated

Intermittent Hormonal Therapy for Prostate Cancer Nicholas Bruchovsky, M.D. S. Larry Goldenberg, M.D., Martin Gleave, M.D., Advances in Urology, vol. 10 (full text)

Clinical Experience with Intermittent Androgen Suppression in Prostate Cancer: Minimum of 3 Years' Follow-Up Goldenberg SL, Gleave ME, Taylor D, Bruchovsky N. Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Mol Urol 1999;3(3):287-292 (abstract)

A pilot study of intermittent androgen deprivation in advanced prostate cancer Horwich A, Huddart RA, Gadd J, Boyd PJ, Hetherington JW, Whelan P, Dearnaley DP. Radiotherapy Academic Unit, Royal Marsden NHS Trust, Sutton, UK. Br J Urol 1998 Jan;81(1):96-9 (abstract)

Treatment of localized prostate cancer with intermittent triple androgen blockade: preliminary results in 110 consecutive patients. Leibowitz RL, Tucker SJ, Oncologist 2001;6(2):177-82 (abstract)

Prostates, Hormones, and Male Sexuality by Nick De Wolfe (1996)

External Beam Radiation

In a recent study comparing 3D-CRT with IMRT, the IMRT delivered higher doses to the prostate and other target tissue with substantially less (unwanted) beam to the bladder and rectum.

Three Dimensional Conformal Radiation (3D-CRT)

Three-dimensional conformal radiation therapy aims radiation to the tumor from multiple directions. The angled beams don't have to pass through as much normal tissue to hit the cancer target. Computerized imaging is used to very precisely map the location of the prostate tumor in three dimensions. If properly planned and carried out, the beams accord with the patient's particular anatomy and the shape of the tumor. This allows for higher radiation dose to the tumor and less to the surrounding normal tissues. During treatment, the patient is immobilized in a mold to aim this increased dose of radiation more accurately to the tumor. Results so far look promising:

3D-Conformal Cuts Complications of Radiation Therapy for Early Stage Prostate Cancer Patients Boston, MA /PSA Rising, NYC/ October 25, 2000

1) Explained with slides in connection with brachytherapy at Kimmel Cancer Center Thomas Jefferson University

Intensity-modulated radiation therapy (IMRT)

Another new technology that can shape and deliver radiation to a tumor while sparing surrounding healthy tissues. The fundamental difference between conventional radiation therapy and IMRT is beam intensity. In conventional radiation therapy, the beam intensity is uniform, but in IMRT, the beam intensity varies across the treatment field. During IMRT treatment, where the tumor is the thickest, the beam intensity is at its maximum, and where the tumor is the thinnest, the intensity is at its minimum. Instead of the patient being treated with a single, large uniform beam, the patient is treated with several small beams, each with different intensities.

Proton and Neutron Beam Radiation Therapy

Similar to 3D conformal radiation therapy. But instead of x-rays, uses protons or neutrons. Protons and neutrons are parts of atoms that can pass through healthy tissues with little damage, while destroying tumor cells at the end of their path. As a result, proton beam therapy may be able to deliver more radiation to the tumor while sparing adjacent tissues. As with 3D conformal radiation therapy, short-term results of proton beam therapy look promising, although studies of long-term effectiveness are not yet available.

See University of Pittsburgh Cancer Institute page about External Beam Radiation Radiation Therapy for Prostate Cancer.

Proton Beam Radiation Loma Linda University Medical Center Proton Center
Fermilab Neutron Therapy Facility "What was once considered to be purely experimental has now become the treatment of choice for certain malignant tumors. Close evaluation of patient response to this treatment modality has clearly identified that neutrons now have a well-established place in the treatment of a number of specific human cancers [including] advanced prostate cancer....." Midwest Institute for Neutron Therapy at Fermilab, Batavia (near Chicago) Il.

Brachytherapy

Cryotherapy

Immunology

For patients with rising PSA following surgery, radiation, or hormonal therapy. For status of the trial and eligibility requirements call :

Amy Bauso, RN (212) 639-6412
Tracy Curley, RN (212) 639-7585
Christine Liebertz, NP (212) 639-7585

Clinical Trials

CancerTrials at the National Cancer Institute (NCI) A guide to the clinical trials process and information about specific clinical trials approved by the National Institutes of Health (NIH).

PDQ Clinical Trials Search Form at NCI

NCI information on Anti-Angiogenesis drugs

CenterWatch Clinical Trials Listing Service

Clinical Trials at University of California, San Francisco, (UCSF)

Clinical Trials at Stanford U Med Center, CA: Genitourinary

Clinical Trials: Prostate at Yale School of Medicine, New Haven CT

Canada: National Cancer Institute of Canada Clinical Trials Group at Queens University, Kingston, Ont., has some links to in-progress clinical trials. See this page for relevant groups including categories including Genito-Urinary trials and Symptom Control.