Prostate Health (cont.)
The great news is that all these other treatments like the IMRT, radioactive seeds or cryotherapy provide very good treatments with very little risk.
The problem with watchful waiting is that if a man has a significant cancer and does nothing, the cancer will continue to grow. If it grows and becomes a problem, usually it's much harder to treat later on than it would have been early on. So we primarily reserve watchful waiting for small volumes of low-grade cancer in elderly men who are likely to die of something else normally, or in men who have such significant health problems that any of the treatments are a threat to them. So, for the majority of men, we're not too happy with watchful waiting.
Now, the question comes up -- how long can we go with watchful waiting? And the answer is probably if it's a low-grade small cancer, you might be able to go years. Studies have show that you can go out 10, 14 years. The problem is, the majority of men, if they live long enough, will still die of prostate cancer. It may be 14 to 17 years later, but these cancers are still growing and they still, no matter how small or benign they are early on, they move in the wrong direction. They become larger and more aggressive.
So he should talk to his urologist and his cardiologist and ideally have the two doctors talk to determine what treatments are reasonable, if any, and in what time frame.
As with all medications, from aspirin all the way up to the most dangerous medicines, there's always potential for side effects. With antiandrogens, one of the risks is that it can injure the liver cells.
A particular level of 70 for some men may be of minimal concern; for others it could be significant. So it's important that the doctors who placed him on the Casodex have monitored the liver function tests over a period of time and discussed this with the primary care physician, and if necessary, a liver specialist, to see if this particular test is at a level of concern and if it's moving in a direction that's not favorable. If it's been 70 on three separate checks, he is doing well with it and the doctors are comfortable watching, then that's totally fine. If it was 28 and then 45 and now at 70 and there's concern -- there are other antiandrogens and other hormonal treatment options that can be used instead of the Casodex.
The advantage to these injections is that it's reversible in the majority. What we know, from research, is that the testosterone does not come back immediately upon completion of the medicine. In fact, men who have been on these medicines for years, oftentimes it can take years for the testosterone to return. So the fact that he just stopped it a short time ago, I'm not surprised he is still having hot flashes, which is a common side effect when the testosterone level is low. It may take months or it may be even years before the hot flashes go away. The good news is as the testosterone levels return slowly, the hot flashes will also start to dissipate.
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.
The good news is that with current aggressive therapies -- with hormone therapy, with total antigen blockade as we discussed with antiandrogens, and with some of the amazing advances not only in chemotherapy but also vaccine therapy, the life span can be many, many years.
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