Prostate
Cancer TreatmentThe success of cancer therapy depends on early detection
and radical removal of all the cancer cells. With prostate cancer this was difficult
to achieve prior to the invention of the PSA test, as there was no way to diagnose
stage A prostate cancer. With the PSA test it is now possible to detect cancer
of the prostate earlier and with the introduction of the selective radical prostatectomy
excellent cure rates of 15 and 20 year survival rates are achieved, which for
practical purposes can be considered a cure.
| Prostate
cancer therapy | | Stage: | Type
of therapy: | | Â A
| selective radical
prostatectomy | | B |
selective radical prostatectomy |
| Â C
| external beam radiotherapy and
bicalutamid (should be replaced by bio-identical progesterone) |
| Â D
| external beam radiotherapy,
bicalutamid ± chemotherapy (see more below) | Here
are the most common treatment methods to deal with prostate cancer. 1.
Radical prostatectomy
In the past with a radical prostatectomy the
nerves supplying impulses to the penis for erection were severed.
However,
now with the help of new technology and the use of an operating microscope the
urologist is able to do a selective radical prostatectomy, which will preserve
penis erection after the surgical procedure is done in most cases. However, the
urologist can only do what is technically possible and unfortunately there will
be some cases where cancer tissue has overgrown the nerve supply and it has to
be removed. In such a case in the interest of the man's survival, the nerve may
have to be severed as the cancer is removed. Overall the statistics show that
about 85% of stage A and B prostate cancer patients can have a successful selective
radical prostatectomy, in other words only 15% lose their potency. There are now
several forms of this surgery:
a) radical retropubic prostatectomy
b) radical
perineal prostatectomy
c) laparoscopic radical prostatectomy
d) robotic
prostatectomy. This latest method combines all others and has the lowest complication
rate. Watch this mini
video, which shows the principal of it.
2. Radiation therapy
including brachytherapy
For stage A and B cancer of the prostate radiotherapy
used to be the "gold standard". In an elderly man who may soon die of
a stroke or a heart attack this might still be the treatment of choice as a selective
radical prostatectomy is a certain surgical risk. The long-term survival curves
are almost identical for the 5-year and 10-year points. However, the 15- and 20-year
survival curves show clearly a survival advantage for the surgical approach.
However,
for stage C and D where the cancer has broken through the tough prostate capsule
surgery gives no survival advantage versus the radiotherapy approach. Therefore
only external radiotherapy is available as an option to marginally improve survival.
Brachytherapy
is a modification of local radiotherapy where radioactive beads are implanted
into the prostate gland and surrounding region. This will damage the cancer cells,
but unfortunately can also damage the healthy tissue in the region. There may
be very special cases where technically brachytherapy is better suited than conventional
external beam radiotherapy. Here is a link
to the Mayo clinic site about brachytherapy. 3. Cryotherapy
With
cryotherapy (like liquid nitrogen) the cancer is treated and removed in combination
with a transrectal ultrasonography (TRUS). Here is a link
about cryotherapy. The problematic with this method is that it is difficult
to know when and whether the last cancer cell was successfully eradicated. Careful
follow-up exams with PSA blood tests and imaging methods need to be done every
6 or 12 months to look for recurrences.
4. Chemotherapy
This
is used for cases where regional or distant metastases of prostate cancer are
present.
Here is a link regarding this treatment:
http://www.prostate-cancer.com/chemotherapy/treatment-description/prostate-chemotherapy.html
5.
High Intensity Focused Ultrasound (HIFU)
Here the prostate cancer is
removed with a high frequency ultrasonic shock wave, similar to how kidney stones
can be removed. Here is a link
that explains HIFU this in detail. The advantage is the simplicity
of the procedure in the hands of a urologist familiar with the treatment. However,
the danger is that some of the prostate cancer could stay behind, which would
not be the case with a selective radical prostatectomy.
6. Active
surveillance (also known as "watchful waiting") With this
method, which is only adviseable in the very early stages, the doctor is following
the patient very closely and uses different tests and imaging methods to see whether
the patient's prostate cancer progresses or stays about the same. Often this method
is used in older, higher risk patients where an invasive surgical procedure may
not be in the best interest of the patient. The down side is that the cancer may
run away while observing and could change from a grade B tumor (still local) into
a stage C tumor with much poorer prognosis.
7. Hormonal therapy
In breast cancer many cancer types have estrogen receptors
and the estrogen blocking agent tamoxifen is used to block cancer growth. Hormone
manipulation was thought to be also effective in the treatment of prostate cancer
as the cancer cells often have testosterone receptors on their surface and the
hope was that cancer growth could be slowed down by removing testosterone or blocking
testosterone receptors. The interesting thing is that newer studies in 1999 and
beyond (see Ref. 12 for details) have shown that prostate cells and prostate cancer
cells have also estrogen and progesterone receptors on the cell surface. This
changed the whole foundation of the traditional belief system and many physicians
and cancer centres completely ignore this fact to the detriment of the prostate
cancer patient. In the past it was thought that growth of prostate cancer
would be significantly reduced when testosterone was removed from the system.
There is a whole industry built around suppressing testosterone in the man who
has prostate cancer when the modern evidence states that testosterone is necessary
for the functioning of all cells in the male and that prostate cancer growth is
not suppressed by testosterone removal (Ref.13). In the past this was achieved
by castration (=bilateral orchiectomy = removal of both testicles) as explained
in the beginning of the prostate cancer
chapter where the findings of the surgeon Dr. Huggins from Chicago were
cited. His publication was in 1941. With the introduction of an analogue to the
hypothalamic hormone called "luteinizing hormone-releasing hormone"
this surgery, which many men were afraid of, was no longer necessary as it is
as effective as a bilateral orchiectomy. However, there are still traces of testosterone
in the system from the adrenal gland metabolism. As Ref. 6 points out this can
be treated with antiandrogenic medication such as bicalutamide (brand name: Casodex).
In a stage C patient the hormone manipulation in that manner will lead to a survival
advantage of 2 years when the treatment is compared to a control group treated
with radiotherapy alone. I do not agree to this regimen and all hormone manipulations
that attempt to remove testosterone, because of the new findings that it is actually
the female hormone, estradiol, that causes the genetic mutations and ultimately
prostate cancer (due to the dysbalance of estrogen/testosterone and the lack of
progesterone). In breast cancer it was proven that estradiol is the culprit that
causes breast cancer. The theory that testosterone would be responsible for the
development of prostate cancer could not be proven. Dr. Lee (Ref. 12) explains
that it is estradiol again that causes prostate cancer in the man (see
below). For this reason I think that it is malpractice to use the testosterone
suppressing agents as described and as still practiced in many cancer clinics.
The
latest about hormone modifications (doing it bio-identically) Newer
insights into the causation of prostate cancer found that prostate cancer often
develops in men who have an excess of fatty tissue (abdominal fat). Due to the
presence of aromatase in the fatty tissue, which is an enzyme that converts male
hormones into estrogens, there is an excess level of estradiol (the main female
hormone) that affects tissues of the body. As these men are typically older than
50 years, these men typically have no discernable progesterone level (or an extremely
low level), which would normally be present in younger men. Estradiol and progesterone
levels in younger men are much lower than in females, but progesterone is relatively
higher than estradiol to prevent cancer from developing. Also the testosterone/estradiol
(T/E ) ratio is 20 or higher in healthy men (Ref.12). Overweight or obese men
have unopposed estrogen (estradiol) in their system with a T/E ratio of less than
20, which is carcinogenic and causes prostate cancer or other cancers. Anti-aging
physicians are trained to look for this subtle hormone dysbalance that can be
determined accurately with saliva hormone tests. Dr. Platt states in Ref. 11 that
men above the age of 50 often have higher estradiol levels than menopausal women.
If there is a low progesterone level, progesterone cream can be administered and
saliva hormone tests can be repeated after 2 to 3 months so that the hormone ratio
of progesterone to estradiol will be increased. This way prostate cancer cells
that carry estrogen receptors on their surface will be kept at bay (prevention
or significant suppression of metastases). At the same time excess body weight
needs to be reduced by exercise and attention directed to reduced calorie intake.
As already mentioned (Ref. 12), Dr. John Lee pointed out that the premise of wanting
to remove testosterone from prostate cancer patients was wrong. It is unopposed
estradiol, an estrogen, which is the cause of prostate cancer. Men with prostate
cancer are deficient in testosterone and progesterone when saliva hormone tests
are done. Hormone deficiencies are treated by replacing what is missing with bio-identical
hormones. Seek a second opinion from an anti-aging physician, before you allow
conventional medicine to ruin your sex life and push you into permanent testosterone
hormone deficiency. Also, understand that only compounded bio-identical hormones
that are applied as creams are acceptable treatment. Artificial hormones are dangerous
drugs that partially inhibit hormone receptors and cause malfunctions in the body
such as heart attacks, strokes, arthritis and cancer. Insist on bio-identical
hormones that are custom-made in compounding pharmacies. More info about
prostate cancer treatment: American Cancer Society: http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?dt=36 Prostate
cancer treatment Guide: http://www.prostate-cancer.com/news/prostate-cancer-news.cfm Prostate
Centre at the Vancouver General Hospital: http://www.prostatecentre.com/patientinfo/patientinfo.php?pageID=21 An
overview
of the various treatments for prostate cancer is given here. Radiotherapy
review from the Princess Margaret Hospital in Toronto, Ont/Canada: http://www.radiationatpmh.com/body.php?id=102&skeywords=prostate
cancer |
