Medical treatment of prostate cancer

The treatment of choice for the management of prostate cancer depends on several factors such as; intensity and severity of disease, age at diagnosis, co-morbid health issues, patient preferences, available treatment options and potential side effects in conjunction with overall health status of the patient.

Active surveillance

Active surveillance is usually adopted in the initial stages when there are no problematic symptoms and the malignant lesion of prostate gland is restricted i.e. no signs of capsular penetration or nodal involvement. Additionally, it is also helpful in men who have serious health issues or those who are not ideal candidates for aggressive treatment plans. Depending upon the patient factors and preferences, the surgeon may not advice immediate intervention (surgical or medical) and instead opt for active surveillance.

This active surveillance of prostate cancer includes regular rectal examination, serological testing for PSA levels, and frequent biopsies (in many instances). Other reasons for choosing active surveillance are;

• Ascertaining if/when to start the radiation therapy or chemotherapy.
• To monitor the progression of disease.

One classic limitation of using this approach is; high risk of metastatic spread to distant organs. Additionally, a lot of people may not remain compliant to the surveillance regimen and may end up developing aggressive illness.

Radiation therapy

One of the most commonly used methods of treating prostate cancer is the use of radioactive isotopes to inhibit the growth of cancer cells. The primary indications for using radiation therapy includes:

• Early or localized disease (the curative or success rate is comparable to prostatectomy)
• Symptomatic management for advanced or localized disease before surgical intervention
• Management of recurrent prostate cancer
• Management of metastatic cancer as an adjuvant to hormonal therapy.

Radiotherapy for the management of prostate cancer can be delivered via:

• External beam radiation: External beam radiation therapy includes the use of high power radiations which comes from an external sources. The dosing frequency and duration varies according to the individual cases.
• Brachytherapy: Brachytherapy include the use of rice size radioactive seeds which are implanted in the prostate region. These radioactive seeds emits powerful radiation and destroy the cancer cells. The emission time of radioactive seed is determined before the implantation, so removal is not needed.

Other types of radiotherapy include; Three-dimensional conformal radiation therapy (also referred to as 3D-CRT), Intensity modulated radiation therapy (also known as IMRT), Stereotactic body radiation therapy (SBRT) and Proton beam radiation therapy.

Side effects of radiation therapy

Although radiation therapy is highly effective against the prostate cancer and other malignancies, the risk of serious side effects is fairly high. For example, according to a new study reported in the New England Journal of Medicine (3), investigators suggested that 94% males have erectile dysfunction at 15-year follow-up after radiation therapy for prostate malignancy; yet only 43.5% report significant sexual dysfunction. Other common adverse effects include;

• Urinary urgency
• Pain during micturition
• Pain while passing stools
• Lymphedema
• Urethral strictures
• Fatigue

Read more about Hormone Therapy and its side effects, Chemotherapy and Biological therapy in the upcoming blog post.