Prostate Cancer: Treating the Disease

by Food and Drug Administration (FDA)

(Page 2 of 2)

Armed with diagnostic data, patients and their doctors must then decide on a treatment course. It is at this point that patients must be well educated, says FDA's Fourcroy. "The decisions made [on treatment] are so crucial and will have such an effect on quality of life, men must weigh them very carefully," she says. "And they must also remember to include their partners in the decisions because they will be affected by the course of action too."

One possible treatment is actually no treatment at all. Doctors call it watchful waiting, and it is best suited for men with a 10-year life expectancy or less who have a low Gleason number and whose tumor has not spread beyond the prostate. The idea is that in these men the cancer is growing so slowly, they likely won't die from it. More radical treatments such as surgery might be more dangerous than simply waiting. Marty Feins, 77, opted for watchful waiting in 1993 when diagnosed with prostate cancer, and he's "going great," he says. Though the Las Vegas man was deemed a good candidate for radiation treatment, he says he did a lot of research and decided his was a prudent course. His PSA level is elevated but is not rising rapidly. "Right now I'm holding steady," he says. "In fact, if I hadn't had a biopsy, I wouldn't even know I have [cancer]."

Californian Jerry Coleman, 61, diagnosed in 1995, opted for a surgical treatment called radical prostatectomy (RP), in which the prostate is completely removed. If performed when cancer is confined to the gland, RP is tantamount to a cure since in theory it removes all the cancer. Coleman says he chose RP because he was unsure of the track record of other treatments. "I felt comfortable that this was the appropriate attack considering my health, age, and the stage of my disease," he says.

Besides being a serious operation that requires weeks of recuperation, RP can have lingering side effects, including impotence and incontinence. Until the early 1990s, virtually all RP patients were saddled with these effects. But "nerve sparing" techniques developed at Johns Hopkins University have preserved urinary and erectile functions in increasing numbers of RP patients. The CaverMap, a device cleared by FDA in 1998, aids surgeons in locating nerve bundles to help avoid severing nerves related to continence and erections when removing the prostate.

Radiation is a treatment option that may be less traumatic than RP and appears to have similar results when used in early-stage patients. Radiation also produces side effects, including impotence, in about half of patients. It can be applied through an external beam that directs the dose to the prostate from outside the body. FDA also has cleared low-dose radioactive "seeds," each about the size of a grain of rice, that are implanted within the prostate to kill cancer cells locally. Called brachytherapy, the seeding technique is sometimes combined with external-beam radiation for a "one-two punch." Studies done at the Georgia Center for Prostate Cancer Research and Treatment show that 68 percent of men treated with both radiation methods applied simultaneously are cancer free 10 years after treatment. Intel Corporation chairman Andy Grove, who was Time magazine's 1997 "Man of the Year," underwent the combined radiation therapy in 1995. According to company spokesman Howard High, Grove, 62, is "in excellent condition" now.

Cryotherapy, in which prostate tumors are killed by freezing, shows encouraging early results. But some medical professionals consider it experimental with not enough long-term data yet to determine its effectiveness.

Hormonal therapy is often used in all phases of prostate cancer treatment to help block production or action of the male hormones that have been shown to fuel prostate cancer. Among widely used approved hormone blockers, often used in combination, are Lupron (leuprolide acetate), Casodex (bicalutamide), Eulexin (flutamide), Nilandron (nilutamide), Zoladex (goserelin acetate implant), and Viadur (leuprolide acetate). Because the testicles produce male hormones, some men also undergo testicle removal to cut off the hormone supply. Advanced prostate cancer patients are usually treated with any number of chemotherapeutic drugs such as Novantrone (mitoxantrone), which do not cure the disease but often do ease pain and other symptoms.

Looking Ahead

Incidences of prostate cancer have dipped slightly in the last five years, says the American Cancer Society. But as FDA's Fourcroy says, there's no "magic bullet" right now that will significantly reduce prostate cancer cases or deaths. As for the future, some strong possibilities exist.

Over a hundred drugs and vaccines for treating prostate cancer are currently in clinical trials. Proposed drugs that may choke off the blood supply to prostate tumors, along with vaccines that rev up the immune system to attack prostate tumors, appear possible.

Treatments based on the hormone IGF-1, which can be a marker for increased prostate cancer risk, are feasible, researchers from McGill and Harvard Universities report.

Studies examining the relationship between diet and prostate cancer have identified a high-fat diet as a risk factor for the disease. Other diet research has shown a possible inhibitory effect for prostate cancer when foods such as soy products and cooked tomatoes are added to the diet.

A study sponsored in part by the National Cancer Institute showed that vitamin E may reduce prostate cancer risk by 30 percent, but NCI stopped short of recommending supplements.

NCI is studying 18,000 men over seven years to determine if the drug Proscar (finasteride) can prevent prostate cancer.

Meanwhile, patients are benefiting from prostate cancer's increasing visibility. "It's finally coming out of the closet," says Howard Waage, 51, a California prostate cancer patient. "It's crucial for us men to be on top of our health, and that's easier to do now than ever."

Out in the Open

Until this decade, not much support or information was available for prostate cancer patients. Then, in the early 1990s, public figures began talking openly about the disease, books and articles appeared, and hundreds of support groups sprang up nationwide. Numerous celebrity deaths from prostate cancer — among them actor Telly Savalas, musician Frank Zappa, and Nobel Prize winner Linus Pauling — were clustered a few months apart. Other personalities, including former Sen. Bob Dole, golfer Arnold Palmer, and retired Gen. H. Norman Schwarzkopf, went public with their experiences. Men started getting the message that the disease can strike any man and that it is possible to survive prostate cancer if it is discovered early enough.

Along with the abundance now of printed prostate materials, the burgeoning popularity of the Internet has helped spawn a new breed of prostate cancer patient, a well-informed man who is in charge of his destiny. Huge amounts of reliable material from organizations such as the American Cancer Society, the National Cancer Institute, and various university hospitals are available online.

Patients also are using the Internet to connect with fellow patients through electronic mailing lists. This allows them to compare notes and get feedback on treatment decisions. Many prostate cancer doctors post messages to mailing lists and answer patient questions.

"I'm not sure I'd be alive today if it weren't for information I've gotten on the Internet," says prostate cancer patient Russ Ingram, who has located experts online who have helped him select the latest treatments for his spreading cancer.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.