I had dinner the other night with a friend of mine. He’s in his late 70’s and seemed to be of robust health. During dinner, however, he told me that he’d had some heart problems for years and he had had a PSA of 8 some years back. Though the PSA hadn’t risen over time, a biopsy discovered a few cells that were cancerous. In addition, he had an enlarged prostate and had to urinate often.
Oh, I forgot to mention. He’s an eminent physician, with a Ph.D., to boot.
So what did he do, knowing all he knew about false positives, PSAs, the fact that prostate cancer is slow-moving, especially in older men, etc., etc.? He and his urologist decided to go ahead with hormone treatment and radiotherapy (radiation.)
I asked him why he did that, since 9 out of 10 men (his figures, not mine) would die with prostate cancer, not of it.
“What about that one man?” he asked.
In other words, he didn’t want to take the risk of being in the 10% of men who would have prostate cancer that slipped the bounds of the gland and went pursuing other organs or the bones. His PSA went to 3 after the radiation, but he still has to urinate often. Who knows what the answer is? But he made his own decision.
Speaking of decisions: I went back to the National Cancer Institute site today to check up on two kinds of treatment for prostate cancer. First, cryosurgery; second, hormone surgery.
I wanted to see if there was any new information on cryosurgery: whether freezing prostate cancer has been definitively settled as a first-rate method. According to the NCI, it has, although it is important to note that cryosurgery is most commonly used as secondary line therapy after radiation therapy, and its effectiveness and side effects are still being hotly debated among urologic oncologists. I mean, if you want to be sure, they say, a prostatectomy is still the surest way to get all of the cancer out of your prostate gland. But cryosurgery can work. And, unlike radiation, it can be repeated if the cancer recurs.
Here are the caveats to cryosurgery:
1. Like its brother, regular surgery, freezing the prostate can still cause impotence.
2. It can cause incontinence.
3. Cryosurgery can be used only for cancer within the gland; it doesn’t work for large areas of the disease.
Now, what about hormone therapy. To my surprise, I discovered that the incidence of use is not dependent on the size of the tumor, its advancement, or its location. More than 20% of the decisions about whether or not to use hormone therapy are the result of which urologist you have. Here’s what the NCI said, specifically:
“The urologist seems to play a role that is at least as important, if not more important, than tumor grade and patient characteristics," says lead researcher Dr. Vahakn B. Shahinian of the University of Texas Medical Branch in Galveston.
The findings suggest that a patient could go to two urologists and receive different opinions about whether to have the treatment, called androgen deprivation therapy because it blocks androgen hormones such as testosterone.
"This scenario is cause for concern because patients might be getting therapy that may not be in their best interest," says Dr. Shahinian.
Approximately half of all prostate cancer patients receive the therapy over the course of their disease. When given with radiation, the therapy can extend the survival of patients with locally advanced disease.
But there are not clear data for urologists to follow about when androgen deprivation therapy should be used for other patients. The treatment is expensive and potentially toxic, with side effects such as an increased risk of fractures and loss of sexual function.
And so it goes, unfortunately.
Published On: October 25, 2006