Prostate Cancer Treatment Update (cont.)
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.
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.
Your age plus the Gleason score and low volume of cancer would make you a particularly attractive candidate for a watchful-waiting program, since it may take many years, as many as 15 to 20, for such a cancer to be clinically a risk to you. That said, cancers may change over time, so close follow-up on a watchful-waiting program, including frequent examinations of the prostate, PSA testing and occasional rebiopsies of the prostate are likely to allow you to know if this cancer is changing.
There is no data currently about whether any treatments given after surgery can definitively prevent recurrence, with the exception of external radiation to the prostate bed. This would be a consideration if your PSA were to continue to rise and if scans did not demonstrate evidence of cancer outside of the prostate bed. Beyond this additional radiation treatment, there still remains very little data about whether treatments such as hormonal therapy, nutritional interventions or other treatments can prevent recurrence.
In your situation I would continue to follow as you are and consider options depending on how fast the PSA is rising, if at all.
Regarding prevention of prostate cancer -- little is known about whether any specific nutritional or drug intervention would decrease your chances of getting prostate cancer. However, epidemiological studies have suggested that certain nutritional interventions for instance, might decrease the general risk of getting prostate cancer. These include a low-fat diet, particularly animal fat, moderate exercise, increased uses of tomato-based products which have an antioxidant called licopene in them and decreased use of dairy products, although this remains controversial. Vitamin E and selenium are also possibly associated with a decreased risk of prostate cancer. However this is a subject of a prevention trial currently ongoing in the United States.
There was another prevention study looking at the drug Proscar published several years ago in the New England Journal of Medicine. This study suggested that men who took this drug had a decreased risk (25%) of prostate cancer after seven years. However, the type of cancers that developed during the study period appeared to be of higher Gleason score, namely more aggressive in appearance. This has led many experts to hold off on the recommendation to routinely take a drug such as Proscar for cancer prevention.
In summary, most of the data here would suggest that some dietary and nutritional interventions might decrease the overall risk of prostate cancer but this has not been clearly proven. A PSA test would be a reasonable thing to consider over the next few years for you.