Prostate Health (cont.)

Stopping fluids two hours before bedtime is a good start. If he is drinking a lot of caffeinated drinks such as coffee, tea or cola drinks or having alcohol such as beer or wine -- those stimulate the production of fluid. So even if he stops two hours before bedtime, his body is still producing the fluid, then he goes to bed, the kidneys continue to produce the excess fluid, and then when he hits a critical amount in the bladder, he gets the message he has to go and wakes up to go. I would strongly suggest that he not only look at the timing of the fluids but what it is he is drinking and consider cutting back dramatically on any alcohol or caffeinated beverages starting in the late afternoon as well as cutting back on the volume in late afternoon.

MODERATOR:
Let's talk a bit about some of the treatment options that a man might have if he does have prostate cancer. Where do you begin?

MARKS:
The first thing we need to know is the particulars of that cancer. Each person that has this cancer is different and each cancer is different. Some are high grade, some are low grade, some are regressive, some are nonaggressive, some are large volume, some are small volume. All of these factors need to be taken into account with the individual characteristics of that particular patient.

We need to know the family history and the longevity in the family. If the parents are still alive in their late 80s, then clearly if he is in his 60s we have a lot of work ahead of us to be sure we keep him alive for his normal expected life span.

We take into account his health. Has he had heart problems? Is he diabetic? Is he a distance runner? All of these factors play into deciding which treatments are best.

At this point, if he can tolerate it, surgery is still the gold standard against which all other treatments are measured. Surgery provides the best long-term cure and disease-free time, but the benefits really don't kick in usually for seven to ten years. Up until that point almost all the treatments are fairly effective. So, if you are young and you have a long life span ahead of you, then for the vast majority, removing the cancer is still the best option.

Radiation, external beam therapy, is an excellent second choice. With new techniques of IMRT or intensity modulated radiation therapy, the ability to get much higher doses with much lower side effects is becoming commonplace now. Instead of having several large beams that overlap in the vicinity of the prostate, the radiation therapists are now able to literally paint the prostate with thousands of pencil-size beams which allows you to get a much higher dose to the gland which provides better killing of the cancer, and a much lower dose to surrounding tissues, so fewer side effects.

In addition to that, radioactive seeds are also a very viable treatment option for many. The doctors will place radioactive pellets -- like little rice particles that are radioactive - into the prostate. Each of these releases a significant amount of radiation, specifically to a particular area, and that also kills the cancer cells.

Cryotherapy is another good option for many men where the prostate gland, instead of being destroyed with radiation or removed, is frozen and the cancer cells and all the tissue cells are frozen and effectively die. That is a very good option not only for men in particular grades and stages of cancer but even if they have radiation failure.

In addition to that, if the cancers are more aggressive, we oftentimes use a combination of therapies. We can also add on hormone therapy, which reduces the cancer's ability to grow because these prostate cancers almost always lead the male hormone testosterone to grow.

And lastly, chemotherapy -- which for many years wasn't good for prostate cancer. Now there have been major breakthroughs that show that certain regimens in combination with some of the other treatments mentioned do provide significant benefits in life span and quality of life.

So it's all very individualized. It's essential not to see ten different options as confusion, but just the ability to be fortunate that they have choices. There are so many other cancers out there where if you have cancer A, you get treatment A, and there aren't a lot of choices. With prostate cancer, because it is so varied and because we have so many options, we can provide a number of choices so that each patient can choose the treatment that they feel most comfortable with.

"It's important for him to not only monitor his PSA levels to make sure the cancer isn't coming back, but also to be monitoring the testosterone levels because that can be a warning sign. If the testosterone comes back and jumps up rapidly and the PSA follows, then we know that he needs to go back on some hormone therapy."

MEMBER QUESTION:
I'm 68 years old and have had two heart attacks. I'm not sure about undergoing surgery. What do you think about watchful waiting?

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