Lesson 3: Prostate Cancer Treatment Options
Non-aggressive Treatment Options and a Fall Back Postion
NON-AGGRESSIVE TREATMENTS:
HORMONE THERAPY: Sometimes hormones are used to shrink the prostate before surgery or radiation (called neoadjuvant hormone therapy). While studies have shown that this approach doesn’t improve the success rate of surgery, the jury is still out on whether it improves the success rate of radiation. However, by shrinking the prostate with hormones before radiation, some men with initially large prostates are safely able to have the higher dose Conformal Radiation, which has been shown to result in higher success rates. The effectiveness of hormone therapy can be monitored by a series of PSA tests (your PSA level should decrease if the hormones are doing their job).
Another approach that is sometimes seen is hormone therapy after surgery or radiation (adjuvant hormones). In this setting, the hormones are generally given for a period of 2 to 3 years. For certain situations, such as men with cancer in lymph nodes at the time of surgery, or men with locally advanced or high-risk disease, hormone therapy in addition to radiation has improved the survival rate.
Hormone therapy reduces the growth of the cancer in some cases, and can give you more time to decide on or make arrangements for your treatment.
As I mentioned before, I am relatively unfamiliar with other forms of non-aggressive therapy, but I will list the more common forms here so you can do your own research, should you decide to go the non-aggressive route:
- Watchful Waiting: this entails following PSA levels to monitor the growth of the cancer.
- Hormonal Therapy: as discussed above.
- Orchiectomy: removal of the testicles, causing an irreversible removal of testosterone.
- Herbal Therapies
Fall back position – what if the treatment you chose does not work? How will you know if your chosen treatment did or did not work? The PSA test, the pathology report, a physical exam and/or certain x-ray tests may be used to determine whether or not the treatment was successful.
In general, the PSA test will give your doctor the earliest clue that everything is going well, but it’s not a perfect test. There may be differences from day to day and from lab to lab. In addition, the same things that could have caused a rise in the blood test before your cancer diagnosis may still influence it now (inflammation of the prostate, recent rectal exam, etc).
What your doctor considers successful will also depend on what kind of treatment you have had.
