Lifestyle changes
Prostate cancer is not something you have to fight by yourself. To get the emotional support you need and to keep abreast of the latest treatment developments join a local support group. This community of men typically shares information and personal stories and helps bolster spirits. Altering your daily habits may also yield promising changes in your survival outlook. Well-known heart disease guru DR Dean Ornish recently reported on an ongoing four-year research study of men's lifestyles. Those who switched to a vegan diet (fruit, vegetables, whole grains and beans), eliminated alcohol, performed three hours of aerobic exercise a week, medicatated daily and attended support group meetings saw a drop of more than 6 percent in their PSA levels in the first year. While not a huge decline, Dr Ornish pointed out that at least their PSAs didn't rise.
PROMISING DEVELOPMENTS
For early-stage prostate cancer, a good portion for certain patients is to undergo nerve-sparing radical prostatectomy surgery. The object is the total removal of the prostate gland and if cancerous, the lymph glands in the pelvis. During the procedure, the surgeon will avoid nerves involved bladder control and erections, although temporary incontinence and erectile dysfunction may occur. With an experienced surgeon, total cure rates can be as high as 90 percent, with erectile ability and bladder control often restored over time.
Another treatment option is external beam radiation therapy. If you go this route, high-energy rays will be used to destroy cancer cells and prevent them from enlarging and migrating. If the cancer has not spread (metastasised), radiation can be used instead of surgery to destroy the cancer cells. In some situations, radiation may be recommended after surgery as well and to treat a recurrence.
Radiation can be delivered using different techniques including external beam radiation therapy (EBRT) or the newer refinements. three-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiation
Best used for early-stage prostate cancer, brachy-therapy involves implanting radioactive 'seeds' into the prostate using an ultrasound transducer for guidance (above left). The seed material varies: some doctors prefer iodine, others use palladium. And the number of implanted seeds ranges between 50 and 80 depending on the prostate size. The seeds emit radiation for upto a year, destroying cancerous tissue in the prostate while spraying health tissues nearby; the seeds don't have to be removed after they stop functioning.
PROSTATE CANCER AND VASECTOMY
One worry that has been around for a while with regard to prostate cancer is the alleged increased risk of developing a tumour following a vasectomy.
This concern was based on findings from some studies that found a slightly increased risk of prostate cancer in men who had been vasectomised. However, the medical experts said at the time the association was weak and there was no plausible biological mechanism that could explain how the two conditions were linked.
The answer came recently with a large, well-respected study from New Zealand failing to find any link between vasectomy and prostate cancer. The researchers compared more than 900 men with prostate cancer to more than 1000 healthy men and could find no increased risk associated with having had a vasectomy at any time in the
25 years prior to the study.
Incidentally, the study also failed to find any significant association between prostate cancer and a number of other suspected risk factors such as smoking, alcohol, number of children or ethnicity.
therapy (IMRT). With any of these, you will receive approximately five miutes of treatment, five days a week for seven to eight weeks, from a special machine that aims radiation at your prostate. The cure rate is about 10 percent less than that with surgery. Side effects include faecal urgency and diarrhoea, and urinary frequency. Impotence is also common two years after surgery.
If you choose brachytherapy (also known as 'seed' therapy), rice-sized radioactive pellets are implanted inside your prostate using a sterile needle guided by ultrasound or MRI (see illustration below). Side effects are rare but may include diarrhoea, rectal bleeding, incontinence and erectile dysfunction. You're a good candidate if you have early-stage prostate cancer, a low risk of disease outside the gland, a PSA of less than 10 ng/ml and a Gleason score of 6 or less. The procedure can often be done on an outpatient basis, typically in about an hour. When compared to other, more time-consuming procedures, seed therapy can seem enticing. However, because its cure rate drops at low as 60 percent over a decade, you have to weigh up the convenience of the treatment against the uncertainty over whether you are getting a defininitve cure for your cancer.
Medications
Sometimes hormonal treatments called androgen-deprivation therapy (ADT) are used to block the production or effect of the male hormone testosterone and to slow the growth of the tumour. Androgen-deprivation therapy may be recommended before surgery or radiation or to shrink prostate glands too large to be eligible for brachytherapy. The most effective methods of reducing testosterone include a bialateral orchidectomy, in which the testes are surgically removed, or daily anti-androgenic tablets, such as cyproterone acetate (Androcur), or a luteinising hormone-releasing hormone (LHRH) agonist. These LHRH agonists are given as depot injections such as goserelin (Zoladex).
>AT BIRTH, THE PROSTATE IS THE SIZE OF A PEA. It reaches walnut size by age 20. When a man turns 40, the prostate often begins to grow again, doing one of three things: It enlarges with no symptoms; it enlarges and then compresses the urethera (the tube carrying urine from the bladder through the prostate), often affecting urination; or it enlarges and then becomes cancerous.
Prostate cancer is not something you have to fight by yourself. To get the emotional support you need and to keep abreast of the latest treatment developments join a local support group. This community of men typically shares information and personal stories and helps bolster spirits. Altering your daily habits may also yield promising changes in your survival outlook. Well-known heart disease guru DR Dean Ornish recently reported on an ongoing four-year research study of men's lifestyles. Those who switched to a vegan diet (fruit, vegetables, whole grains and beans), eliminated alcohol, performed three hours of aerobic exercise a week, medicatated daily and attended support group meetings saw a drop of more than 6 percent in their PSA levels in the first year. While not a huge decline, Dr Ornish pointed out that at least their PSAs didn't rise.
PROMISING DEVELOPMENTS
- A particularly exciting approach in counteracting metastatic cancer is the use of monoclonal antibodies (special injectable proteins) that zero in on prostate cancer cells in the blood and destroy them. Ongoing clinical trials in New York City look quite promising.
- Erectile dysfunction (ED) is a common side effect of both radical prostatectomy and radiation therapy. The original phosphodiesterase 5 (PDE 5) inhibitor Viagra has helped many men with ED restore their erections. Recently two similar ED drugs have become available--tadalafil (Cialis) and vardenafil (Levitra).
For early-stage prostate cancer, a good portion for certain patients is to undergo nerve-sparing radical prostatectomy surgery. The object is the total removal of the prostate gland and if cancerous, the lymph glands in the pelvis. During the procedure, the surgeon will avoid nerves involved bladder control and erections, although temporary incontinence and erectile dysfunction may occur. With an experienced surgeon, total cure rates can be as high as 90 percent, with erectile ability and bladder control often restored over time.
Another treatment option is external beam radiation therapy. If you go this route, high-energy rays will be used to destroy cancer cells and prevent them from enlarging and migrating. If the cancer has not spread (metastasised), radiation can be used instead of surgery to destroy the cancer cells. In some situations, radiation may be recommended after surgery as well and to treat a recurrence.
Radiation can be delivered using different techniques including external beam radiation therapy (EBRT) or the newer refinements. three-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiation
 |
| 'SEED' THERAPY (BRACHYTHERAPY) FOR PROSTATE CANCER |
PROSTATE CANCER AND VASECTOMY
One worry that has been around for a while with regard to prostate cancer is the alleged increased risk of developing a tumour following a vasectomy.
This concern was based on findings from some studies that found a slightly increased risk of prostate cancer in men who had been vasectomised. However, the medical experts said at the time the association was weak and there was no plausible biological mechanism that could explain how the two conditions were linked.
The answer came recently with a large, well-respected study from New Zealand failing to find any link between vasectomy and prostate cancer. The researchers compared more than 900 men with prostate cancer to more than 1000 healthy men and could find no increased risk associated with having had a vasectomy at any time in the
25 years prior to the study.
Incidentally, the study also failed to find any significant association between prostate cancer and a number of other suspected risk factors such as smoking, alcohol, number of children or ethnicity.
therapy (IMRT). With any of these, you will receive approximately five miutes of treatment, five days a week for seven to eight weeks, from a special machine that aims radiation at your prostate. The cure rate is about 10 percent less than that with surgery. Side effects include faecal urgency and diarrhoea, and urinary frequency. Impotence is also common two years after surgery.
If you choose brachytherapy (also known as 'seed' therapy), rice-sized radioactive pellets are implanted inside your prostate using a sterile needle guided by ultrasound or MRI (see illustration below). Side effects are rare but may include diarrhoea, rectal bleeding, incontinence and erectile dysfunction. You're a good candidate if you have early-stage prostate cancer, a low risk of disease outside the gland, a PSA of less than 10 ng/ml and a Gleason score of 6 or less. The procedure can often be done on an outpatient basis, typically in about an hour. When compared to other, more time-consuming procedures, seed therapy can seem enticing. However, because its cure rate drops at low as 60 percent over a decade, you have to weigh up the convenience of the treatment against the uncertainty over whether you are getting a defininitve cure for your cancer.
Medications
Sometimes hormonal treatments called androgen-deprivation therapy (ADT) are used to block the production or effect of the male hormone testosterone and to slow the growth of the tumour. Androgen-deprivation therapy may be recommended before surgery or radiation or to shrink prostate glands too large to be eligible for brachytherapy. The most effective methods of reducing testosterone include a bialateral orchidectomy, in which the testes are surgically removed, or daily anti-androgenic tablets, such as cyproterone acetate (Androcur), or a luteinising hormone-releasing hormone (LHRH) agonist. These LHRH agonists are given as depot injections such as goserelin (Zoladex).
>AT BIRTH, THE PROSTATE IS THE SIZE OF A PEA. It reaches walnut size by age 20. When a man turns 40, the prostate often begins to grow again, doing one of three things: It enlarges with no symptoms; it enlarges and then compresses the urethera (the tube carrying urine from the bladder through the prostate), often affecting urination; or it enlarges and then becomes cancerous.
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