Prostate Cancer Treatment Update (cont.)
That said, many urologists will operate on men over the age of 70 if they are otherwise in good health. But, it should be clear to patients that surgery has not been clearly proven to be superior to treatment such as radiation or seeds in all situations.
Generally there has been less data in the use of cryosurgery as primary treatment, but single institution studies have shown this treatment can effectively treat localized prostate cancer. We just don't know if it's as good as or less effective than other options. In the area of recurrent disease, there has been more enthusiasm for cryosurgery as an option. However, these remain relatively small studies of selected patients in a small number of centers around the country.
As discussed earlier in the context of surgical intervention after radiation, there may be a role for cryosurgery in some patients with local recurrence after more standard options such as radical prostatectomy or seed implantation.
It would be considered premature at this point, in my opinion, to use chemotherapy if the only sign of this refractory cancer is a rising PSA. That said; the goal of treatment here is to try to suppress and delay the cancer from growing in this hormone refractory state.
Secondary hormone treatments include high dose Casodex, ketoconazole, and estrogen type treatments. These are generally best discussed with a medical oncologist, and I might suggest a consultation with a medical oncologist be conducted in the near future to review these choices.
The good news is there is a lot of research going on in this area, in addition to these standard options I mentioned. For instance, a recent study in hormone refractory disease was presented at a prostate cancer meeting in Florida that suggested that a vaccine called Provenge improved survival in patients who received this compared to a placebo. This vaccine is not commercially available and there are ongoing studies, but it points out that promising new treatments are on the horizon.
So in my opinion, I do not believe men should be overly concerned that biopsies spread cancer. In fact, cancers spread themselves, and this is the greatest concern of all.
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