Prostate cancer

MEDICATIONS

Hormonal manipulation aims at lowering testosterone levels. Since prostate tumors require testosterone, reducing the testosterone level is often very effective in preventing further growth and spread of the cancer. This can be done either through surgical removal of the testes or by using medications. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread. Preliminary evidence suggests that it may improve cure rates when combined with radiation or surgery. However, this is still under investigation.

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Synthetic drugs like Lupron or Zoladex that mimic the function of LHRH (luteinizing hormone releasing hormone) are being used increasingly to treat advanced prostate cancer. These medications suppress testostorone production. The procedure is often called chemical castration, because it has the same result as surgical removal of the testes, although it is reversible, unlike surgery. The drugs must be given by injection, usually every 3 months. Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, and erectile dysfunction (impotence).

Other medications used for hormonal therapy include androgen-blocking agents (such as flutamide) which prevent testosterone from attaching to prostate cells. Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.

Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology specialist will usually recommend a single drug or a combination of drugs aimed at destroying the cancer cells. Medications that may be used to treat prostate cancer include:

Mitoxantrone
Prednisone
Paclitaxel
Docetaxel
Estramustine
adriamycin

Most men receive their chemotherapy (after the initial dose) on an outpatient basis at a clinic or physician's office. Possible side effects are numerous and specific to a given chemotherapy drug.

LIFESTYLE CHANGES

Surgery, radiation therapy, and hormonal manipulation all have the potential to disrupt sexual desire or performance on either a temporary or permanent basis. Discuss your concerns with your health care provider. Additionally, several options are available for managing sexual problems related to prostate cancer treatment.

MONITORING

You will be closely monitored for progression of the disease regardless of the type of treatment you receive. Monitoring will include:

Serial PSA blood test (usually every 3 months to 1 year)
Bone scan or CT scan to evaluate for metastasis
Complete blood count (CBC) to monitor for signs and symptoms of anemia
Monitor for other signs and symptoms indicating disease progression, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness

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