Prostate Cancer Treatment Update
WebMD Live Events Transcript
William K. Oh, MD, from the Dana-Farber Cancer Institute, joined us on March 23
to discuss the latest treatments for prostate cancer.
The opinions expressed herein are the guests' alone and have not been
reviewed by a WebMD physician. If you have questions about your health, you
should consult your personal physician. This event is meant for informational
purposes only.
MODERATOR:
Welcome to WebMD Live, Dr. Oh. Thank you for joining us today. We have a number of questions from our members. Let's get started on them.
MEMBER QUESTION:
I am confused about my doctor's recommendation regarding the use of Proscar and/or Avodart for benign prostatic hyperplasia (BPH). I am using Proscar but have experienced a declined sex interest plus a decline in ejaculation. Does one treatment have an advantage over the other?
OH:
Both Proscar and Avodart are hormonal therapies
used for the treatment of benign enlarged prostates. They do not have a role in
the treatment of cancer currently, although this is being investigated. They do have some of the side effects noted by you and in the situation of symptoms related to BPH, different options do exist, including drugs like Flomax. I would say in this situation there's really no advantage of Proscar over Avodart or vice versa.
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| "The high-risk patient should always get hormones, intermediate may benefit from the addition of hormones to radiation and low risk should generally not receive hormones with radiation." |
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MEMBER QUESTION:
What are the advantages and disadvantages of having a combination of hormone therapy with radiation therapy, as opposed to just radiation therapy alone? What types of patients are good candidates for combination therapy?
OH:
We generally divide patients with localized prostate cancer into three categories of risk -- low, intermediate and high.
- High-risk patients are those with Gleason scores of 8 to 10, prostate-specific antigens (PSAs) over 20 or large tumors on examination called T3 tumors. Such patients should always have hormonal therapy combined with radiation unless there's an absolute reason they cannot receive hormones.
- Intermediate-risk patients are those who have a PSA between 10 and 20, a Gleason score of 7 or a tumor that can be felt with the finger, T2. In this situation a recent study suggested six months of hormones may make radiation better but this remains somewhat controversial. Some people believe that in the intermediate risk, higher doses of radiation may accomplish the same goal.
- Low-risk patients are those with the PSAs under 10, tumors you cannot feel on a prostate exam and a Gleason score of 6 or below. These patients probably do not need hormonal therapy with radiation.
So the high-risk patient should always get hormones, intermediate may benefit from the addition of hormones to radiation and low risk should generally not receive hormones with radiation.
MEMBER QUESTION:
Notwithstanding that it is always an individual decision and there are differences in each patient, what is the current treatment of choice for a 55-year-old male with prostate cancer isolated to the prostate (Gleason of 3 from one of the 10 biopsy sites, PSA of approximately 24 and prostate approximately double the size of normal)?
OH:
This is a difficult question to answer since different options exist in this situation and no studies have proven one type of treatment is superior to another.
Surgery would be considered an option but the patient's PSA would be considered a higher risk feature and make it more likely there may be some more cancer outside the prostate. Hormones combined with radiation therapy would be considered another option.
Other options exist and because there's no single standard of care, this decision is best made by consultation with a multidisciplinary group of physicians, including a urologist, a radiation oncologist and if available, a medical oncologist.
MEMBER QUESTION:
Is surgery still an option if cancer reoccurs after seed implants or radiation therapy?
OH:
Surgery after seeds or external radiation is associated with a higher risk of complications than if it is performed prior to such treatment. It is the subject of a clinical trial that is ongoing nationally.
In most circumstances patients whose cancers were not cured by seed implants or external radiation would not be good candidates for surgery. But, individual circumstances differ and options need to be considered in light of the higher risk of complications.
MEMBER QUESTION:
I have prostate cancer (PC). When it was first diagnosed the biopsy showed one of eight samples had cancer. I am 81 years old. My cancer is T2 and my Gleason score is 3+3=6. I elected to go on "watchful waiting" and hope to outlive the cancer. I go to my doctor two times a year for checkups. Do you think this is a wise choice for me or should I be more aggressive with treatment? I had transurethral resection of the prostate (TURP) right after diagnosis and none of the tissue had any cancer.
OH:
Watchful waiting is considered a reasonable option for patients with lower grade smaller volume cancers. In particular, it's a reasonable option for older patients for whom a slow-growing cancer may not be a potential risk to their lives. Of course, we do not know the optimal patient at this time that does not need any treatment for their cancer. That is why watchful waiting is only one of a list of choices in this type of circumstance.
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