Prostate cancer treatments more advanced than ever

Published 5:20 pm Friday, September 8, 2017

How many of you know someone with prostate cancer? I am willing to bet that is almost everyone who is reading this article.

About 161,360 men will be told they have prostate cancer this year. It is the most common cancer in men (after skin cancer). The estimated lifetime risk for a man to develop prostate cancer is 1 in 9. I have discussed before the importance of discussing prostate cancer screening with your doctor. However, for those men diagnosed with prostate cancer, current treatment options are more promising than ever. I thought I would spend this column in discussing them with you.

One of the treatment options receiving the most endorsement is actually no treatment at all! There is an adage that states, “More men will die with prostate cancer than from prostate cancer.” This means that just having prostate cancer does not mean that you will die from it. Certainly there are many prostate cancers that are diagnosed at an early stage and are of such low aggressiveness that they will never be a significant threat to a man during his lifetime. Now that does not mean that we simply ignore them, or pretend they don’t exist. For these men, we recommend either “watchful waiting” or “active surveillance.” With watchful waiting, we follow a man’s PSA and prostate exam on a periodic basis. The ideal cancers for this more laidback approach are very low volume (small) and very low grade (non-aggressive) cancers. We know that these cancers have a very low likelihood of spreading and are not a threat to most men. With active surveillance, we take a more active approach. These patients have either a larger volume or more aggressive cancer but still with a low risk of spread. In these patients, we follow their PSA much closer, and will repeat their prostate biopsy on a periodic basis. This allows us to know if the cancer is growing or becoming more aggressive.

This approach is often used in younger patients who are going to require surveillance for an extended period of time.

In patients whose cancer is not amenable to surveillance, we have several options.

Surgical removal is still a mainstay of treatment. There are some patients where clearly this is their best option. However, there is growing evidence that other treatment options, particularly some forms of radiation, have equal cure rates with better quality of life and fewer side effects. Radiation therapy can be given as “external beam,” which is the traditional form of radiation. However, the techniques and technology currently used continue to improve, and the radiation you would receive today is not “your grandfather’s radiation.” Implantation of radioactive “seeds,” known as brachytherapy, is another commonly used form of radiation treatment. This involves an outpatient procedure at the hospital which can be performed in a morning with the patient home shortly after lunch. There is minimal recovery time, and I release the patient to full activity one week after the procedure. There are other, less commonly used forms of treatment such as cryotherapy, proton therapy and HIFU that have certain benefits, but also drawbacks to use. These are not currently recommended as standard treatment for most patients.

When prostate cancer spreads, it is known as metastatic disease. In prostate cancer, that typically involves spread to the bones or internal organs such as the lymph nodes or liver.

This is the stage of prostate cancer where there is the most excitement and advancements in treatment. Traditional treatment revolves around the blockage of testosterone, or male hormone. Typically an injection is used, which the patient receives twice a year. Only a few years ago, once hormonal therapy started to fail, the last option was chemotherapy. Now we have three newer medications to use. Immunotherapy is an advancement, which uses the patient’s own immune system to attack the prostate cancer. This involves a series of infusions, which are given at the Marion L. Shepard Cancer Center. Studies have demonstrated increased survival from the cancer with this treatment. There are also two oral (pill) medications that now are used along with the hormonal medication injections, which work better than our previous medication combinations. These are very well tolerated and demonstrate a very good response. Finally, we do still use chemotherapy for advanced prostate cancer. There continues to be advancements with this and current regimens offer the best response rates we have ever seen.

So while the new diagnosis of prostate cancer can be a devastating thing psychologically, there is more hope now than ever. Cure rates and response rates with current therapy are at an all-time high. Research and new treatments continue to advance our ability to cure and treat this common disease. Current treatments attempt to achieve a balance between curing the disease and maintaining quality of life. We, at Vidant Urology, as well as the providers at the Marion L. Shepard Cancer Center, work closely with the major referral centers such as UNC and Duke to offer the most up-to-date care available right here at home. I hope you or your family members never are diagnosed with this disease, but you can take comfort in knowing that the treatment of this disease continues to advance rapidly.

Dr. Michael Crawford is a urologist at Vidant Urology in Washington at 1202 Brown St. Crawford can be reached by calling 252-946-0136.