Prostate Cancer (cont.)
What about herbal or other alternative medicine treatments for
prostate cancer?
Alternative medicine, also called integrative or
complementary medicine, includes such non-traditional treatments as herbs,
dietary supplements, and acupuncture. A major problem with most herbal
treatments is that their composition is not standardized. Moreover, the way
herbal treatments work and their long-term side effects usually are not known.
One new treatment for prostate cancer, new at least in the
United States, is an herbal medicine called PC Spes. The name comes from PC,
which stands for prostate cancer, and Spes, which is the
Latin word for hope. In some initial trials of PC Spes in men who have failed
the traditional treatments (hormonal therapy and chemotherapy) for advanced
prostate cancer, this herbal medicine appeared to be promising. More rigorous
studies are ongoing to evaluate more fully the risks and benefits of this
treatment.
What is watchful waiting?
Watchful waiting is observing a patient while no treatment
is given. Such a patient usually has an organ-confined tumor and no symptoms.
Understand, however, that although watchful waiting involves no actual
treatment, the patient still needs close follow-up and monitoring. The
follow-up involves frequent visits to the doctor, perhaps every three to six
months. The visits include questions about new or worsening symptoms and
digital rectal examinations for any change in the prostate gland. In addition,
blood tests are done to watch for a rising PSA and imaging studies can be
conducted to detect the spread of the cancer. If the history, examinations, or
any of the tests signal the possibility of an advancing cancer, the watchful waiting
usually is discontinued and treatment is recommended.
This option of watchful waiting actually has been chosen
over a therapeutic intervention, such as surgery or radiation, in up to 30% of
patients who have organ-confined (localized) prostate cancer. The main reason
for taking a course of watchful waiting is that prostate cancers generally grow
more slowly than most other cancers. Thus, many localized prostate cancers
found at an early stage can take years or sometimes even decades to spread
locally and metastasize. Therefore, watchful waiting seems to make sense for
organ-confined (localized) prostate cancers in men who are elderly. It is also
a reasonable decision in men who have tiny (seen only with a microscope) tumors
and a low PSA (for example, in the 4-10 range or lower). Additionally, watchful
waiting often is the most appropriate choice in men who are ill with other
serious medical diseases, such as heart or lung disease, poorly controlled high
blood pressure, diabetes, AIDS, or other cancers.
Watchful waiting in prostate cancer, however, remains
controversial. Some medical authors have stated outright that it is not a good
choice. They point out that few doctors would just watch other cancers to see
whether they would spread without treatment. Furthermore, the treatment for an
individual could become less effective in the future if and when the cancer
does progress. Finally, one expert summarized some recently published
information on watchful waiting. He indicated that among men with organ-confined
(localized) prostate cancer, the development of distant spread (metastasis) and
death from the cancer was 50% higher in those who received no treatment
than in those who underwent surgical removal of the prostate (radical
prostatectomy).
Next: Can prostate cancer be prevented? »
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