Prostate Cancer: “Which treatment is the right treatment?”

Posted June 13, 2007 at 08:47 AM by Jessica Galvano

Section: His Health

With various treatment options including “watchful waiting”, hormone therapy, radiation, chemotherapy, and surgery, many men are anxious to know which of these methods will be most effective in a battle against prostate cancer. Although decision factors account for a patients’ age, quality of health, and stage of the cancer, a recent study has discovered the predominant determinant: oncology or urology.

In a collaborative effort, Dr. Thomas Jang (urologist) and Dr. Justin Bekelman (oncologist) of New York’s Memorial Sloan-Kettering Cancer Center have established a correlation between the type of specialist seen and a patients’ chosen treatment plan. The urologist-oncologist team studied more than 85,000 men with prostate cancer over an eight-year period. For men over 65 that received treatment without consulting an oncologist, nearly 70% opted for a surgical procedure.

The overwhelming coincidence of urologist-based advice and surgery contrasted sharply with the treatment decisions of men that had seen both a urologist and oncologist. After consultations with both specialties, 78% of men elected to undergo radiation rather than surgery.

However, a presentation of these findings to the American Society for Clinical Oncology earlier this month raised the question: “Which treatment is the right treatment?”

The answer? It depends.

Doctors often reserve “watchful waiting” for patients whose cancer is slow to progress, or for older patients at risk of experiencing more severe reactions to aggressive treatments.

For cancer that develops at a faster rate, however, treatment often involves a more active approach. In the form of injections or pills, hormone therapy inhibits tumor growth by counteracting or suppressing testosterone production, but cannot cure the disease. 

Radiation, either administered externally or internally with radioactive seed implants, has the benefit of being able to isolate cancerous from non-cancerous cells.. Because radiation allows for treatment of affected areas without damage to surrounding tissue it is the most popular treatment option among men of any age.

To treat advanced or aggressive cancers, doctors often resort to chemotherapy. While this treatment is highly effective, it also has the reputation of causing less than desirable side effects including nausea and vomiting, decreased appetite, and hair loss. In addition to these temporary side effects, chemotherapy is associated with the long-term possibility of infertility.

Despite the successful potential of other treatments, most younger, healthy men opt for surgery. Of the available surgical procedures, a prostatectomy is the traditional yet more invasive option, requiring a sizeable abdominal incision. In recent years laparoscopic techniques have gained popularity as a way to avoid a large scar and lengthy hospital stay. Unlike a prostatectomy, laparoscopic surgery is minimally invasive and patients typically recover in less than a month. Because no treatment is without risk, Dr. Jang and Bekelman recognize the importance of an informed decision. Although the advice of a specialist can facilitate the selection of a suitable treatment, both specialists agree that the choice is ultimately a personal one.

A few of our research sources and for more information: [CNN], [MSNBC / Newsweek], [WebMD]