Prostate cancer is a slowly progressing tumor with few symptoms. The most common symptoms are similar to those of BPH, and most of them are more severe (localized invasion or metastasis to distant sites), including bone pain and weight loss, only in advanced stages. Early diagnosis and treatment may lead to a better outcome for the patient.
The three most essential tools to check for the presence of adenocarcinoma in the prostate are the DRE, prostate specific antigen (PSA), and transrectal ultrasound (TRUS). If the results of the prostate biopsy confirm the presence of cancer cells, further tests such as computed tomography, MRI, bone scan, and Gleason’s score will help to understand the stage of prostate cancer. If the cancer is confined to the prostate gland, it is classified as stage T1 or T2 (limited prostate cancer); stage T3 means that the cancer has invaded the prostate tegument or seminal vesicles; and if the cancer has metastasized to other organs, such as the bones, liver or lungs, it is considered terminal (N+ or M+).
Treatment of Prostate Cancer
Several factors influence the treatment of limited prostate cancer, including expected survival, physical condition, and quality of life requirements. Based on the average life expectancy of 77 years for men in Taiwan, men aged 70 years should expect to live longer than 10 years. For patients with limited prostate cancer, radical prostatectomy or radiation therapy is the best treatment.
Complications of radical prostatectomy include urinary incontinence and sexual dysfunction, while nerve-sparing prostatectomy may preserve sexual performance in selected subpopulation patients.
Scott and Boyd used hormone therapy in the 1960s to reduce the size of the prostate gland and turn lesions that could not be treated surgically into tumors that could be removed surgically. Destructive therapy includes surgical removal of the G-sphere or the use of luteinizing hormone (LH-RH) analogs (e.g., Zoladex or Leuplin) for destructive purposes, as well as anti-androgen drugs (e.g., Casodex, Flutamide, and Androcur). Debulking can be used as neoadjuvant therapy (before surgery or radiation), adjuvant therapy (after surgery or radiation), or, as in most cases, in the treatment of severe disease such as metastatic cancer (N1 or M1).
Today’s radiation therapy is effective in controlling limited prostate cancer and is a life-extending option for patients. The 10-year survival rate for radiation therapy is approximately the same as for radical prostatectomy, so radiation therapy is a good option for patients who do not wish to undergo radical prostatectomy. For some metastatic lesions, radiation therapy may also provide pain relief.
For recurrent prostate cancer that does not respond to debulking, or for prostate cancer with poorly controlled multiple metastases, second-line debulking or chemotherapy may be considered. Herbal extracts (such as PC-SPES), as well as current research and development of gene therapy and immunotherapy, may also offer another opportunity.
What are your options?
Some questions must be asked.
1. Is your prostate cancer really limited? Or has it metastasized?
2. Is this cancer really progressing slowly?
3. What is your physical condition? Do you have the means to withstand surgery?
4.Are you still young? Will prostate cancer, although progressing slowly, endanger your health in the future?
5.Can you tolerate the complications and inconvenience caused by the treatment of prostate cancer?
6.Is urinary incontinence, hematuria or abnormal bowel movements a big problem for your social activities or work?
7.Do you care about abnormal sexual function and inability to get an erection?
8.What is your final choice if you cannot balance life, health, and quality of life?
The choice of treatment will affect the final outcome of the disease in the future, so it is important that you discuss it fully with your physician and even seek medical re-consultation.
How to deal with prostate cancer?
The invention of the PSA test has changed the way we think about this disease. Prostate cancer is the most common malignancy in the United States and is on the rise in Taiwan. However, prostate cancer progresses slowly and has a relatively good prognosis. Therefore, if we can be vigilant and undergo PSA screening, if we are unfortunate enough to have prostate cancer, we can overcome the disease and live a more dignified life if we can work together with our medical professionals to face it courageously and choose a treatment that can balance health and quality of life.