Prostate Cancer (cont.)
What are the treatment
options for prostate cancer?
Deciding on treatment can be daunting, partly because the
options for treatment today are far better than they were ten years ago, but
also because not enough reliable data are available on which to base the
decisions. Accordingly, scientifically controlled, long term studies are still
needed to compare the benefits and risks of the various treatments.
To decide on treatment for an individual patient, doctors
categorize prostate cancers as organ-confined (localized to the gland), locally
advanced (a large prostate tumor or one that has spread only locally), or
metastatic (spread distantly or widely). The treatment options for
organ-confined prostate cancer or locally advanced prostate cancer usually
include surgery, radiation therapy, hormonal therapy, cryotherapy, combinations
of some of these treatments, and watchful waiting. A cure for metastatic
prostate cancer is, unfortunately, unattainable at the present time. The
treatments for metastatic prostate cancer, which include hormonal therapy and
chemotherapy, therefore, are considered palliative. By definition, the aims of
palliative treatments are, at best, to slow the growth of the tumor and relieve
the symptoms of the patient.
What are the differences between hormonal treatment and chemotherapy?
Hormonal therapy is the mainstay of treatment for symptomatic advanced prostate cancer. Patients without symptoms, but with advanced disease, do not appear to have improved survival with treatment when compared with untreated patients. Therefore, treatment of patients with asymptomatic advanced disease is not essential. The treatments available for hormonal therapy are:
1. Orchiectomy is the surgical removal of the testicles.
2. Luteinizing hormone-releasing hormone agonists, otherwise known as Lupron and Zoladex, and antiandrogens, specifically a drug called Casodex,
each produce symptomatic relief in about 80% of patients. Improvement is often dramatic.
3. Other agents that are helpful include the following: progrestins such as megastrol acetate given daily orally and other drugs that inhibit androgen production such as aminoglutethimide or ketoconazole. These agents are effective but are difficult to tolerate. Corticosteroids are often given simultaneously. As opposed to hormonal therapy, chemotherapy provides relief in only 20-25% of symptomatic patients with prostate cancer. Various regimens are being used. Estramustine, cisplatin, 5-FU, vinorelbine, and mitoxantrone are the most popular agents. However, recently Taxol has become the drug of choice used by oncologists in treating hormone-resistant prostate cancer.
When to use hormonal therapy and chemotherapy depends on the nature of the prostate cancer itself. If the prostate cancer is hormone-sensitive, then hormonal therapy is the therapy of choice. When the cancer becomes hormone resistant
(for example, manipulation of the hormone levels has no effect on the prostate cancer), then the only potential therapy available to the patient is chemotherapy. Chemotherapy, then, is used generally when advanced prostate cancer is hormone-resistant. Unfortunately, chemotherapy coming after hormone therapy is nowhere near as effective as hormonal therapy because the cancer itself has often evolved to become more aggressive so that the prognosis is significantly worse. When patients' prostate cancer goes from being hormone-sensitive to hormone-resistant, the prognosis has taken a significant turn for the worse and the chemotherapy option at that particular time is usually the only treatment option available.
Other factors considered in choosing treatment include the
age, general health, and preference of the individual and the Gleason score and
stage of the cancer. The results of the PSA test sometimes also can help to
decide on the treatment. For example, a borderline elevation of the PSA (4-10),
if shown to be due to a prostate cancer, suggests that the cancer is confined
to the gland. If other tests also point to an organ-confined tumor, surgery or
possibly radiation can be considered to attempt a cure. In contrast, a very
high PSA (for example, over 30 or 40) raises the possibility of metastases. If
the metastases are then confirmed by other tests, the treatment options would
be limited to hormonal therapy or chemotherapy.
PSA tests also should be done periodically after treatment
to help assess the results of treatment. For example, an increasing PSA
suggests growth or spread of the cancer, despite the treatment. In contrast, a
decreasing PSA indicates improvement. As a matter of fact, a post-treatment PSA
of zero may indicate complete control or cure of the cancer.
- goserelin-injection, Zoladex - Consumer information about the medication GOSERELIN - INJECTION (Zoladex), includes side effects, drug interactions, recommended dosages, and storage information. Read more about the prescription drug GOSERELIN - INJECTION.
- CT Scan (Computerized Axial Tomography) - CT Scan (Computerized Axial Tomography, CAT scan) is a procedure that assists in diagnosing tumors, fractures, bony structures, and infections in the organs and tissues of the body.
- Prostatitis - Read about prostatitis, a painful infection of the prostate gland. Symptoms include fever, chills, painful urination, lower back pain, pain in the genital area, and frequent urination.
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