20% Men get Prostate cancer -  A survival guide to Advanced Prostate Cancer Treatment?

Prostate cancer kills 25,000 men each year. While one in five men get prostate cancer, only 3% die from it. It is the second most common cancer in men next to lung cancer. As a man ages, he has a greater risk to develop prostate cancer. Family history is significant too. It is also well established that African- American males have a higher risk than white males.

Survival outcomes are determined by multiple factors. The stage of the disease is crucial. Is it localized within the gland capsule or spread outside the prostate gland and to other sites such as bone. Also, the pathologist grades the biopsy specimen according to the Gleason score or Whitman-Jewett system. The score helps determine the therapy proposal of the doctor.

There are several treatment methods for men with prostate cancer. Treatment is determined according to the physical health of the patient as well as the stage of the tumor. In men who are very elderly or not physically robust, watchful waiting may be preferred. The doctor and patient do nothing unless symptoms occur that must be treated.

Hormone therapy can be considered. Blockage of the male hormone stops the growth and spread of the tumor. It may shrink. Simple castration can be done safely or drugs that block testosterone can be taken by the patient, or both. Many times hormone therapy is used first to shrink the tumor so a patient can undergo radiation and/or surgery.

All stages of cancer can be treated with radiation therapy. It can be used if surgery fails or the cancer returns. Radiation may be combined with hormone therapy as well. Cancer cells are killed by the radiation. The biggest advances in therapy of the prostate involve the use of radiation. Brachytherapy and external beam radiation are used today for treatment. In brachytherapy, radioactive implants are placed in the tumor field which then kills the nearby cancer cells. This is for low to moderate cancer risk patients and very popular today. Beam radiation has several forms but essentially delivers a high energy beam to the tumor site. It is given daily over several weeks. These methods are both great modern advances in treatment of prostate cancer.

Surgery comes in several forms. It can be used to treat all stages. Transurethral resection is the simplest in which a scope is inserted through the penis and tumor removed by resection locally. This is generally used when the tumor is localized to the prostate or to treat urinary blockage due to tumor growth. Radical prostatectomy is performed for more advanced tumors. It can be open or laparoscopic depending on site, size and stage of tumor and the patient’s overall health status. A new advancement in surgery is the robot assisted laparoscopic prostatectomy. It may be a great improvement over open surgery with less risk, less side effects and more rapid recovery for the patient. We await the data to prove its superiority. Surgically, this is the greatest advancement in prostate surgery that we have seen in the last several decades.