Prostate Treatment
By Rear Adm. Joyce Johnson, D.O., M.A.

I recently was diagnosed with prostate cancer. What are my options for treatment?

For men, prostate cancer is second only to skin cancer as the most common type of cancer. One-fourth of all cancers in men are of the prostate. Risk increases with age; about 30 percent of men in their 50s and 70 percent of men in their 80s have at least microscopic areas of prostate cancer. Only about 10 percent of men with prostate cancer will have clinically apparent disease.

Prostate cancer grows slowly relative to other cancers and often can be diagnosed before it spreads. Screening blood tests (such as the psa [prostate specific antigen]) and more effective biopsy techniques have enabled prostate cancer to be diagnosed early, when treatment is most effective. There are four basic therapies for treating prostate cancer: "watchful waiting," surgery, radiation therapy, and hormonal treatment.

Watchful waiting is usually reserved for those cancers that appear slow-growing on biopsy. It also is recommended for older men with other significant illnesses, especially those for whom the side effects of cancer treatment pose a serious threat.

The most definitive surgical treatment is the radical prostatectomy, or total removal of the prostate. Side effects can include diminished sexual function and urinary control. If cancer cells are confined to the prostate, the long-term prognosis is excellent.

External radiation therapy involves a beam of radiation pointed toward the prostate to kill the cancer as well as adjacent cells. Brachytherapy, also called internal or implant radiation, is a newer therapy in which many small radioactive "seeds" are implanted into the prostate. This treatment usually is limited to patients with small, confined tumors. Long-term studies are still ongoing.

Hormonal therapy prevents prostate cancer cells from receiving the male hormones they need to grow. This can be accomplished surgically or with drugs that prevent the testicles from making testosterone, prevent the adrenal glands from making androgens, or block the effects of male hormones. Hormonal therapy usually is recommended for cancer that has spread or as a temporary treatment to complement surgery or radiation.

The best treatment varies for each patient. Discuss treatment options with your doctor (and perhaps with a urologic surgeon and a radiation oncologist) before deciding on a treatment plan. For more information, visit the Department of Defense Center for Prostate Disease Research Web site via TROA's links page, www.troa.org/magazine/links.asp.