Prostate Cancer (cont.)
Jay B. Zatzkin, MD, FACP
John P. Cunha, DO, FACOEP
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
Cryotherapy is most frequently used as a salvage treatment after failure of radiation therapy. As an outpatient, hollow needles are placed into the prostate through the perineum (the space between the scrotal sac and the anus) under image guidance. A gas is passed through the needles to freeze the prostate. Warm liquid is passed through the urethra at the same time to protect it. The needles are removed after the procedure. While potentially effective for local control of cancer in the prostate gland, the side effects can be significant and include pain and the inability to urinate. Potential long-term effects include tissue damage in needle-insertion areas, impotence, and incontinence. Cryotherapy is not an appropriate primary treatment for management of prostate cancer.
Prostate cancer is highly sensitive to and dependent on the level of the male hormone testosterone, which drives the growth of prostate cancer cells in all but the very high-grade or poorly-differentiated forms of prostate cancer. Testosterone belongs to a family of hormones called androgens, and today front-line hormonal therapy for prostate cancer is called androgen deprivation therapy (ADT).
In the past, this was accomplished by surgical castration called bilateral orchiectomy. In that procedure, the testes were both removed. Today, doctors can block the function of the testes in a controllable and REVERSIBLE fashion with drugs which affect the hormone system of the body and stop the main driver of the testes, the pituitary gland at the base of the brain, to stop stimulating the testes to make testosterone. These agents can result in shrinkage of the prostate gland, can stop prostate cancer cells from growing for up to many years, and can relieve pain caused by prostate cancer which has spread or metastasized into the bones.
Hormonal treatment today is primarily used in the treatment of locally advanced and metastatic prostate cancer. It can be combined with radiation therapy in attempts to cure prostate cancer. Its primary role is in the treatment of widespread or metastatic prostate cancer. While it is not a curative treatment in that setting, it can both reduce symptoms and prolong life.
Today medicines used to block testosterone production by the testes include:
Both surgical and medical castration result in impotence. They also can cause hot flashes, fatigue, and thinning of the bones (osteoporosis) over time. These drugs may be given individually or combined in what is called a combined androgen blockade. The combined blockade approach has not been proven to be more effective at this time than orchiectomy (removal of the testes) and is more expensive.
Other hormonal treatment options include:
Medically Reviewed by a Doctor on 11/12/2015
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