Basic Information on Prostate Cancer-Part I of a VI Part Article

(8/31/11)Forty-six percent of men who underwent radical prostatectomy reported worse-than-expected urinary incontinence one year after the operation, and 44% did so for sexual dysfunction, even if they had about 20 to 45 minutes of counseling before surgery, according to a study in the Journal of Urology. Researchers even found that 12% to 17% of men thought they would have improved bladder control and erection after the operation.

(9/5/10)- In their recently released book, "Invasion of the Prostate Snatchers" Ralph A. Blum and Mark Scholz, M.D. the authors assert that most of the 200,000 newly discovered cases of prostate cancer are over-treated.

According to the authors "active surveillance" would be the most effective initial treatment for the disease for most men.

Messers Blum and Scholz assert that only about 1 in 7 newly diagnosed prostate cancers are at risk for a serious form of the disease. To reinforce their claim, the authors point out recent research studies such as the results of one that was published in the New England Journal of Medicine that showed that a radical prostatectomy extended the lives of just 1 patient per 48.

Out of 50,000 radical prostatectomies performed every year in the United States, Dr. Scholz wrote, "more than 40,000 are unnecessary."

(6/6/08)- The results of a study of laparoscopic radical prostectomy surgery "demonstrates that there are hidden risks for patients who opt for laparoscopic or robotic surgery", according to Dr. Jim Hu, an instructor of surgery at the Harvard Medical School the lead author of the study.

Laparoscopic operations for prostate cancer result in fewer immediate complications and quicker recovery than the more common open procedure, but it also increases the chance for longer term problems that require further therapy.

The results of the study which were published in the May 10th edition of The Journal of Clinical Oncology examined a sample of 2,702 Medicare patients undergoing radical prostatectomy, the complete removal of the prostate, from 2003 to 2005.

The number of minimally invasive procedures has increased dramatically over the last few years so that they constituted 31% of this type of operation in 2005 from 12.2% in 2002. Laparoscopic surgeries resulted in a 27% lower risk of complications during and immediately following the operation.

The laparoscopic patients needed an average of 1.42 days in the hospital compared with more than 4 days for those who had open surgery. But, the laparoscopic group of patients had a 40% greater risk of scarring that interferes with organ function, a complication that required additional surgery. Within 6 months of the laparoscopic surgery, more than 1/4th of the patients needed additional hormonal or drug therapy compared with one in ten of those who had conventional surgery.

(5/26/07)- Normally the FDA will follow the recommendation of its advisory panels in making it final determination, but the agency put off final approval of a drug that may have shown that it extended the life of some seriously ill prostate cancer sufferers for up to 4 1/2 months.

The drug in question is Dendreon Corporation's prostate-cancer vaccine Provenge. The FDA asked the company to provide more data to support the claim that Provenge does extend the life of the patients in the study. The company now has a 500-patient study looking at that question. The FDA "approvable letter" could mean another two years at least until the product reaches patients.

In the case of Provenge, the advisory panel voted 13-4 in favor of recommending approval, even though evidence from two clinical trials was weak in showing benefits.

It is estimated that prostate cancer causes about 27,500 deaths a year in this country and strikes an estimated 218,000 Americans. In the case of Provenge, both of the studies submitted to make the case for approval failed to meet their primary "endpoint's of showing a slowing of growth in the tumors". The studies also showed an increased risk of strokes among patients taking the medication

A side study indicated however that patients taking the drug lived 4 1/2 months longer than those who did not take it. The drug represents a new approach to cancer treatment called immunotherapy. It is referred to as a "vaccine" because it is intended to marshal the body's immune system into attacking the tumors.

(1/25/07) Lung cancer is the leading cause of cancer mortality in the United States, with 160,390 deaths expected in 2007. The death rate for men has been decreasing lately, but it still is increasing in women because they quit smoking later than did men. Because of an aging population however, the number of new cases of prostate cancer will continue to increase.

It is estimated that 219,000 new cases of prostate cancer will be found in 2007, of whom about 27,000 will die.

In the latest figures from the American Cancer Society the number of total deaths from cancer decreased by 3.014 from 2003 to 2004. These are the latest years for which figures are presently available. This is the second year in a row that the total number of deaths from cancer has decreased in this country. Although that is a small decrease it shows that some progress is being made in the fight against the disease.

In 2004 there were a total of 553,888 deaths that were attributed to cancer. The greatest decrease in cancer deaths have been in colorectal cancer.

(12/9/06)- The December 1 issue of the New York Times carried an article by Stephanie Saul, entitled "Profit and Questions as Doctors Offer Prostate Cancer Therapy". The article discussed the usage of intensity modulated radiation therapy (I.M.R.T.) for the treatment of prostate cancer.

I.M.R.T was introduced in the mid-1990s and involved multiple beams of radiation to a small area while at the same time avoiding exposure to healthy tissues. The procedure involves a large time commitment by the patient since it requires a visit to a radiation center 45 times over the course of nine weeks. The procedure can involve a cost as high as $47,000 per patient, with Medicare picking up some of the cost. Individual insurance companies have their own cost structures in the case of this procedure.

Reimbursement in the Atlanta area, considered close to the national median, is set to be cut by 8.2 percent, from $39.000 this year to $35,800 in 2007.

About 240,000 American men will learn that they have prostate cancer this year. How many of them will have the course of their treatment determined by one of the 10,000 urologists in this country based on the equipment that the doctor has rather than by what is the best recommended treatment for the patient?

Medicare and other insurance companies typically pay urologist only $2,000 or less for performing surgery to remove prostate cancer or for implanting radioactive seeds therein. As with surgery and seed implant, men treated with I.M.R.T run a risk of eventual impotence. A recent study at Memorial Sloan-Kettering Cancer Center in New York City found that eight years after treatment, 49% of men who were potent before treatment, developed erectile dysfunction.

(4/14/06)- Brachytherapy treatment for prostate cancer involves the application of localized ionizing radiation from a source that is either implanted in the body in the form of seeds or through catheters, or that is applied directly to the skin surface near the affected organ. It is considered a one time treatment, unlike high dose radiation therapy, but has a higher association with urinary problems.

(2/5/05)- The Prostate Cancer Foundation is introducing an online prostate cancer clinical trial database that catalogues all trials in more than 500 locations. (  

(7/29/04)-Abbott Labs has filed an application with the FDA to approve usage of its drug atrasentan before the completion of the final results of a second ongoing trial of the drug, because it has slowed progression of the disease by 20% in patients with advanced prostate cancer. Companies usually have to show that a new drug is effective in at least two large studies to get approval to market a drug.

The FDA gave fast-track approval to the drug becauseit would help patients who have no other treatment options. The drug could be on the market by the second half of 2005, and will be sold under the brand name of Xinlay.

The PSA test was initially used to look for the recurrences of cancer after men had been treated for the disease. It was not until the 1990s that the test began to be used as an evaluative test in determining the extent and the need of the aggressiveness for treatment of cancer of the prostate. At that time cancer experts agreed that when the PSA reading exceeded four nanograms of protein in a milliliter of blood, doctors would recommend biopsies to see if a cancer is present.

Dr. Ian M. Thompson, chief of urology at the University of Texas Health Science Center in San Antonio was the lead investigator for a recent study that determined that there appears to be no level at which there is no risk of prostate cancer. The study involved 2,940 men aged 62 to 91. Prostate cancer kills about 30,00 men a year, so developing a test that can have a high degree of predictive value can certainly be life saving. While higher levels of PSA confer a greater risk, there appears to be no level at which there is no risk of prostate cancer. There are many health professionals who already argue that the test already over-diagnoses prostate cancer, and that there is absolutely no justification to even lower its boundary level.

A study of nearly 30,000 men has found that frequent sex does not increase the risk of developing prostate cancer. Michael Leitzmann, a researcher at the National Cancer Institute, led the study. The study involved 29,432 health professionals ages 46 to 81 who were asked about their ejaculations in their 20s, 40s and during the previous year 1991.

In eight years of follow-up, 1,449 men developed prostate cancer. On average the men had four to seven ejaculations a month. No increased risk of prostate cancer was seen in men who reported more frequent ejaculations. The two highest levels of activity were linked with decreased cancer risks. One theory is that frequent ejaculations help to cleanse out cancer-causing chemicals or reduce the development of calcifications that have been linked to prostate cancer.

Secretary of State Colin L. Powell, who is 66 years of age, was the latest high profile individual to undergo surgery for prostate cancer. After the operation was completed his doctors at Walter Reed Army Medical Center said that his cancer was "localized", and confined to the prostate. Mr. Powell waited several months after his problem was discovered. According to Dr. Peter T. Scardino, chairman of urology at Memorial Sloan-Kettering Cancer Center in New York the decision to wait several months before surgery should not be a significant factor in his outcome

Heart disease was the leading cause of death in the U.S. last year followed by cancer in the number two slot. Lung cancer will cause an estimated 157,000 deaths in the U.S. this year, followed by colon cancer (57,000), breast cancer (40,000) and prostate cancer (29,900). According to a report from the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society and the North American Association of Central Cancer Registries, the death rate has declined for all four of these types of cancers since 1990.

Prostate cancer is the second most common cancer in men, after skin cancer. One in every six men will develop it. According to the American Cancer Society about 230,900 new cases will develop it.

The results of a study done by researchers led by John D. McConnell of the University of Texas Southwestern Medical Center in Dallas showed that two drugs commonly used to treat men with enlarged prostates are more powerful and effective when use in combination. The disease, benign prostatic hyperplasia is the leading cause of urinary tract problems in older men. As many as 60% of the 14 million men in this country older than 65 are estimated to be suffering from this problem.

The two drugs-Merck & Co.'s Proscar (finasteride) and Pfizer Inc.'s Cardura (doxazosin) produced better results in treating the problem than if the drugs were used separately. Cardura works by relaxing muscles of the bladder and prostate, while Proscar reduces the size of the gland, but it takes about 6 months to a year for Proscar to work. The researchers followed 3,047 men with urinary-tract symptoms for 4 1/2 years. The subjects were divided into four groups: Those receiving placebo, Proscar, Cardura or both drugs. The study found that those using the combined drugs had a two-thirds reduction in the risk of the condition worsening during the study period than those taking the placebo, while the reduction in those taking the drugs separately was only 39% for Cardura and 34% for Proscar. The risk of urinary retention was slashed by 81% when the dual drug approach was used.

According to the results of a study done by the Southwest Oncology Group in San Francisco, the drug that is sold by Merck & Co. under the brand name of Proscar (finasteride) is both more effective in preventing prostate cancer but is also potentially more dangerous than expected. After a group of 4,300 healthy older men were given a daily dosage of the drug for seven years, researchers found that the men's chances of getting prostate cancer were 25% lower than for those of a like-size group who took only placebos.

Of the group that took the finasteride, 6.4% ended up with a particularly aggressive form of prostate cancer versus 5.1% who got the cancer in the placebo group. The study group was lead by Dr. Charles A. Coltman Jr., who is chairman of the Southwest Group. He stated that it is up to the individual and his physician to determine if the risk is worth taking. He also stated that the National Cancer Institute halted the 10-year study some 15 months early because the results had clearly demonstrated the drug's mixed effects.

In addition to the increased risk of the more aggressive form of prostate cancer, the other negatives involved in taking the drug included erectile dysfunction and reduced libido. Finasteride has been used to treat benign prostate hyperplasia (enlarged prostate) since 1991. The same drug sold under the name of Propecia and administered in one-fifth the standard dose, is used to treat baldness.

A new scanning technology has proven to be very effective in determining how far a prostate malignancy has spread, and thus cuts down on the type of surgery that the patient may need. By injecting a chemical solution into patients blood and viewing it through MRI equipment, doctors have found that they can effectively determine whether cancer of the prostate has spread to the lymph nodes.

Under this process, tiny iron oxide particles are injected into the blood stream and they then work their way towards the lymph nodes. A healthy lymph node will absorb the particles, while a diseased one does not absorb it. The MRI will show a healthy lymph node as a shade of black, while diseased nodes show up as white. The iron oxide pellets are manufactured by Advance Magnetics Inc. of Cambridge Mass.under the name of Combidex. The company is trying to win approval from the FDA for the process, and recently the National Cancer Institute has brokered a meeting between the FDA and the company to discuss approval issues.

The study of this process took place at Massachusetts General Hospital under Mukesh G. Harisinghani, and at ther University Medical Center in Nigmegen, Netherlands. The only side effect found among patients scanned was back pain in a small area where the agent was infused. The study consisted of a small group since only 80 patients were tested using the new scanning technique and also the old MRI technique. Combidex is expected to cost between $100 to $200 when it comes to market.

The U.S. Preventive Services Task Force has dropped its objection to routine PSA screening tests for millions of middle aged and elderly men, saying it is possible that the test does save lives. It did however stop short or recommending the test, citing continued uncertainty about their value. In doing so it abandoned its 1996 opinion that they are not effective enough to justify the cost.

Autopsies have found that half of all men over the age of 50 have cancerous cells in their prostates, yet only 3 percent of men die of prostate cancer. Some studies have shown that when life threatening tumors do show up, the death rates are generally the same among men who had regular screenings and those who didn't go to a doctor until they developed symptoms. Other studies have shown that those who get the screening have a higher survival rate.

Until recently there had  been a great deal of controversy about the cost effectiveness of the prostate specific antigen (PSA) test. An opinion piece in the San Francisco Chronicle written by the editors of the Western Journal of Medicine raised quite a controversy on this issue. The editors, Drs. Michael Wilkes and Gavin Yamey, suggested that the PSA test might cause more harm than good.

They pointed out the unreliability of the test and presented a sophisticated argument about how false positive test results cause considerable morbidity related to complications of prostate biopsies. They also presented the fact that the test picks up slow growing tumors that would never have become clinically apparent and the final bombshell that there is no evidence that screening all healthy men would change the outcome of the disease. (Some of these arguments are being used to question the use of mammograms as recently reported in the New York Times.)

After the op-ed piece appeared, the authors were bombarded with letters and email accusing them of possibly having the deaths of thousands of men on their hands. Letters also followed to the chancellor of the University of California, who along with BMJ Publishing Group owned the Western Journal of Medicine, asking (many with stronger words) that the university take disciplinary action against the writers of the op-ed piece.

Interestingly, we spoke to a practicing doctor at a hospital in New York and asked her about the PSA testing. She reported to us that, during her medical school training, she was taught that the PSA test was "murky" at best and should only be used in high-risk cases. She spoke of pressures brought by patients who are influenced by the barrage of advertising that they are exposed to in local media.

In defense of the article, Dr. Gavin Young is quoted as saying: "Our piece provoked the angry and often abusive backlash because it challenged the widespread belief in America that every man should know his PSA. This belief is promoted by an extremely powerful pro-screening lobby, which has a major financial stake in diagnosing and treating prostate cancer."

Does this erosion of medicines moral base point to the self-serving nature of medicine, rather than an altruism that most of us would hope is the norm? Is society driven by the politics of the lobby groups and therefore glosses over the need for highly qualified unbiased research data? What motivates people to want the latest and more costly diagnostic tests or pharmaceutical drugs, yet by doing this, subjecting themselves to high-risk morbidity situations? We do not know the answers to these questions. We do know that it is important to get unbiased factual information into consumer’s hands.

Two years ago, this writer had the pleasure of reading Dr. James Le Fanu’s book entitled "The Rise and Fall of Modern Medicine" (Carroll & Gray Publishers, New York). In the book he explores the post war glories of modern medicine. He "analyzes the factors that for the past twenty-five years have increasingly widened the gulf between achievement and advancement…[and] also clearly identifies the challenges and perils that medicine faces in the twenty-first century."

In the final pages of his book, Dr. Le Fanu poses the following challenge: "Genuine progress, optimistic and forward-looking, is always to be welcomed, but progress as an ideological necessity leads to obscurantism. The question as to how to maximize the possibilities of the former, while rejecting the latter, is best resolved by accepting at face value the version of events as revealed by this historic account, where the last fifty years are best seen as one episode, albeit a very glorious one (indeed a culminating one), in a historical tradition that stretches back over the past 2,500 years.

The time has come to relocate medicine back within that tradition so eloquently evoked by Sir William Osler. The timeless virtues of judgment and good sense might then triumph over the shallow restlessness of the present through a reaffirmation of the personal human relationship between doctor and patient…This reaffirmation of the central tenet of medical practice may, or may not, mean that doctors in the future will be less inclined to ‘regret’ their chosen career, but the public will certainly have less reason to be unduly concerned about their health or to look elsewhere for help with their medical problems."

We can think of no better way to end this article. We encourage our readers to send us their thoughts about medicine in general or about prostate testing in particular. Dialogue does not have to be strewn with invectives and name-calling. In the spirit of American democracy lets put speech to work in our best interest.

The FDA has approved GlaxoSmithKline PLC's Avodart for symptomatic benign prostatic hyperplasia in men with an enlarged prostate to improve urinary symptoms, reduce the risk of acute urinary retention and reduce the need for surgery.

One of the biggest dilemmas faced by anyone with prostate cancer is the choosing of the best treatment methodology. A 10-year study comparing early surgery to watchful waiting was done at the Regional Oncologic Center in Uppsala, Sweden and it indicated that early surgery should be the preferred way of treatment of the disease. The study has followed the lives of only 695 men in Sweden so much more work has to be done in this area.

According to Dr. Lars Holmberg, a professor at the center, "Now we have better information underlying the talk that the patient and the doctor have to have together to decide what treatment to take." The American Cancer Society estimates that 189,000 men will be diagnosed with the disease and that 30,200 will die from it.

Of the 695 men in the study, all of whom were in the age category of 60 to 70, and all of whom had been diagnosed with the mild form of prostate cancer. Some of the men had surgery done to remove the cancer while others were treated with benign neglect or watchful waiting. After eight years, 13.6% of patients in the watchful-waiting group died of prostate cancer, compared with 7.1% of the surgery patients. The cancer had spread to other organs in 27% of the waiting group compared with 13% in the surgery group, and the risk of a local recurrence of a tumor was nearly 20% for the surgery group, but about 60% in the watchful waiting group.

The California Department of Health Services, in conjunction with the U.S. Food and Drug Administration, ordered a nationwide recall of the herbal supplement PC-Spes because of possible contamination. The recall meant that the distributors of the herbal product had to alert all their customers to return all bottles to the manufacturers.

The supplement is a blend of Chinese herbs in a capsule form that is often recommended by oncologists when traditional prostate cancer treatment such as chemotherapy fails, or is not the preferred method of treatment by the patient. It is estimated that there are about 10,000 men in this country who are taking the supplement. Many of these individuals believe that they are alive and healthy today as a result of taking of PC-Spes.

Although the FDA oversees manufacturing of herbal supplements, so that they are safe when taken, the FDA does not oversee the more rigorous manufacturing requirements that are required of prescription drug manufacturers. In additional there are no requirements for these supplements to be clinically tested and the data then must be submitted to the FDA before the drug can be approved for usage by the public.

PC-Spes has received considerable support from oncologists as a last resort treatment for prostate cancer. BotanicLab sells the capsules by mail order through a network of direct distributors in the U.S. Botanic says that it has hired an outside laboratory to conduct a new round of tests, and California officials say they are willing to review the new results. The recall was ordered after California health authorities found traces of warfarin, a blood thinner, in the capsules. Lupron and Casodex are 2 hormone-blocking drugs that are commonly used in the fight against prostate cancer.

This year over 198,100 men will be diagnosed with prostate cancer and 5 out of 6 of them will survive. According to the American Cancer Society, an American male has a 16% chance of developing prostate cancer during his lifetime, and a 3.4% chance of dying from it.

Robert S. Miller, the recently confirmed director of the Federal Bureau of Investigation was recently operated on for prostate cancer. Mr Miller was back on the job 4 days after his operation. Joe Torre the New York Yankee manager completed his six-week radiation treatment at New York's Memorial Sloan-Kettering Cancer Center Hospital after being operated on for prostate cancer. Nelson Mandela, South Africa's first black president has been undergoing anit-antigen hormonal treatment intended to shrink the prostate gland, to make it more responsive to radiation therapy.

On the other hand, Mayor Rudy Giulianni of New York opted for the seed implantation method of treatment for his prostate cancer. All have stated that they have had no side effects from the treatment other than being a little tired. Mr Torre stated that he would have to undergo radiation and chemotherapy for about 2 1/2 years. Arnold Palmer, the golfer has also been in the news publicizing the treatment of his prostate cancer .

Dr. William J. Catalona operated Mr. Torre on for prostate cancer on March 18, 1999 at Barnes-Jewish Hospital in St. Louis. Dr. Catalona, of Washington University, a urologic surgeon and prostate cancer researcher helped to develop the PSA test in 1989. Dr. Catalona said that he had removed Torre's prostate gland and the surrounding lymph nodes. The operation lasted 2 1/2 hours.

The radical prostatectomy that was performed involved removing the prostate gland at the base of the bladder, while carefully separating it from the nerves located along the wall of the rectum. Incontinence or impotence are 2 of the possible side effects of the operation. According to the results of a recent study conducted under the leadership of Janet Stanford of the Fred Hutchinson Cancer Research Center in Seattle impotency will afflict 6 of 10 men who have had prostate-cancer surgery. About 8% of the men who have had the surgery will become incontinent. The study was based on the self-evaluation response of 1,291 men who had undergone the surgery. These results suggested a much higher level of these problems than had been previously thought to be the case.

Recently an experimental drug has come along in the battle against advanced prostate cancer. In Phase II trials the results of tests of atrasentan, made by Abbott Laboratories show that the drug apparently slows the progression of cancer in the very sickest men for whom conventional hormone drugs no longer work. It seems as if the drug has been well tolerated by the men on whom the drug was used and it significantly reduced the spread of cancer in their bones. Abbott has begun Phase III tests of the drug, so it will not be until at least 2002 that we know the results of these tests.

The prostate makes some of the milky fluid (semen) that carries sperm. The gland is the size of a walnut and is found just below the bladder, which stores urine. The prostate wraps around a tube (the urethra) that carries urine from the bladder out through the tip of the penis. During orgasm muscles squeeze the prostate's fluid into the urethra. Sperm, which are made in the testicles, also go into the urethra during orgasm. The milky fluid carries the sperm through the penis during orgasm.

Benign prostatic hyperplasia (BPH) is an enlarged but otherwise normal prostate. It arises as a result of the normal aging process in men. More than half of all men over 60 will suffer from it, and by age 80, 8 out of 10 men will suffer from it. As the prostate grows it squeezes the urethra (urinary tube), and leads to the frequent need to urinate. We will discuss hereafter, the determination that the condition is not benign, but rather is cancerous.

The test that all males over 50 have most frequently been advised to take is the Prostate-specific antigen (PSA) test. It is a blood test that can be helpful in determining whether the prostate is cancerous or not. The March 1999 issue of Medical Herald reported that "with many respected urologists saying the test is worthwhile and others saying it has little value", there is a need for a consensus-building conference of experts to debate the issue. The PSA test is based on the observation that the prostate secretes a protein that is pumped into the blood stream. Cancerous cells secrete a higher than normal amount of this protein and consequently results in a higher PSA reading, indicating the presence of cancerous cells.

There is a large body of opinion that feels that the test should not be given and also causes much unnecessary anxiety since it is not 100 % accurate and it costs money to take the test. As of January 1, 2000 the PSA test has been administered free as part of Medicare's Preventive Benefits Program (see our article on this subject).

Ask your physician his opinion and use your own judgment. Since the growth rate of cancer cells decreases with age some competent medical opinion feel that the very elderly should not be subjected to the extreme treatment involved in prostate cancer treatment. If you have taken the test and the PSA level exceeds the normal range of up to 5, follow up testing takes place.

This does not mean that if you have lower than a 5 level you are "safe". On the other hand, having a higher than 5 reading doesn't mean you have cancer. Some men have a genetic tendency towards higher readings. A friend of this writer had a 25 (yes 25) reading, and now, a year later his level is down to 8.

He was treated with Proscar and hormones and his doctor has adopted a wait and see approach since his biopsy showed that his cancer was benign. A relatively new drug Proscar can cause the prostate to shrink, but it does not remove the cancer cells. The PSA test is not conclusive in determining if the cancer is malignant. If the initial test has a high or suspicious reading the urologist will have a follow-up PSA test administered. The urologist should perform a number of other tests including sonorgram, prostatic palpation, transrectal ultrasonography and sextant biopsies for definitive diagnosis. Usually time is not of the essence so go slowly before making any final decisions.

Prostate cancer is the most frequently diagnosed cancer among U.S. men. It is the second leading cause of cancer deaths in U.S. males. Lung cancer is the leading cause of death amongst males claiming about 90,000 lives a year. Initially the cancer patients are divided into 3 groupings: high risk, intermediate risk and low risk.

One of the criteria used to establish which risk group a patient belongs in is established through medical family history information. Did any other male member of your family have prostate cancer? Diet and smoking are 2 other criteria used to establish the risk group for a patient. American blacks are considered to be in a higher risk category. After the urologist examines the patient he will draw samples for a biopsy. The biopsy is extremely important in determining if there is a malignancy, and if so, how far it has spread. He will discuss the options available to you after he receives the biopsy report.

We strongly suggest that after you have gotten the urologist's opinion that you seek out a second opinion. There usually is no need to act immediately. Each individual must draw his own conclusions based on the input he receives. There is no magical one answer being the right answer. If you opt for surgery ask the surgeon if you will be sexually impaired after the surgery. We have been told that if you opt for radiation treatment, surgery no longer becomes a viable option available to you.

The most effective treatment for prostate cancer depends on the stage of the disease and how aggressive the doctor feels that the cancer is. The leading treatments for this disease are as follows:


  • Radical prostatectomy-Used to treat cancer that is confined to the prostate. The entire prostate gland is removed along with some surrounding tissue.
  • Transurethral resection-Part of the prostate gland is surgically removed using a tool with a small wire loop on the end. The tool is inserted through the urethra up to the prostate gland.
  • Cryosurgery -This is the latest surgical technique that is being currently evaluated for its effectiveness. This surgery involves inserting a metal probe directly into the tumor tissue and destroying the tumor by freezing it.


Radiation Therapy- In this treatment, high energy x-rays kill or shrink cancer cells. It is used to treat prostate cancer that is still confined to the prostate gland or has spread only to nearby tissue.

  • External beam radiation is like getting an x-ray but for a longer time. It is usually performed in and outpatient cancer center. Usually one treatment per day is given 5 days a week for a period of 6 or 7 weeks. Each treatment lasts only a few minutes.
  • Internal radiation therapy uses small radioactive pellets (each about the size of a grain of rice) that are implanted directly into the cancerous cells of the prostate. These pellets or seeds give off radiation for weeks or months in small amounts. This procedure is known as brachytherapy.  

Hormone Therapy-This treatment is often used for patients whose prostate cancer has metastasized (spread to other parts of the body) or has recurred after treatment. The goal of this therapy is to lower the levels of the male hormone, testosterone. Reduced testerone levels can make the prostate cancer shrink or grow slower. There are several methods used for hormone therapy:

  • Orchiectomy: This procedure involves surgical removal of the testicles.
  • Luteinizing Hormone-Releasing Hormone (LHRH) analogs: These drugs decrease the amount of testosterone produced by a man's body. LHRH analogs are injected monthly or every three months at the physician's office or at the oncology center.
  • Anti-androgens: It is used in conjunction with orchiectomy and LHRH analogs and blocks the body's ability to use testosterone. 

Chemotherapy-Uses powerful anti-cancer drugs that are given to patients either intravenously or taken orally. It can be done in a doctor's office, an outpatient clinic, or even at home.

Men are also often treated with hormone therapy in conjunction with these other treatments. Depending on the age of the individual benign neglect is another possibility to consider. In a September 1998 study of 1,872 men with localized prostate cancer reported in the Journal of the American Medical Association of those at high risk for spreading the disease beyond the prostate, radical surgery was the most effective treatment. For those at intermediate risk, radioactive implants plus hormone therapy proved as effective as radical surgery.

Another study in the same journal done on 767 men with localized prostate cancer, those with cancers considered low risk faced only a 4% to 7% chance of dying from their disease within the next 15 years when either no treatment was given or only hormonal therapy was used.

Depending on which type of treatment is used and the type of work an individual is engaged in will usually determine the length of incapacity. That period can vary from as short as 3 weeks to as long as about 3 months. Andy Grove the former Chairman of Intel Corp. wrote an article on this topic in the May 13, 1996 issue of Fortune magazine when he was diagnosed with prostate cancer.

If you are interested in reading this article go to the archives section of (we do not have permission to create a link herein). He evaluated the different options available for 9 months before he undertook the type of treatment he opted for. Cooked tomatoes have a substance called lycopene that may be a possible protector against this disease. Do not base your decision on getting this "over" as soon as possible.

The results of a study of lycopene's protective ability against prostate cancer were revealed at a meeting of the American Association for Cancer Research on April 12, 1999. Researchers at the Karmanos Cancer Institute in Detroit under the leadership of Dr. Omar Kucuk did the study. The study involved only 33 men who either took 2 15-milligram capsules of lycopene or nothing for 30 days before their prostate operations.

Studies done after the operations showed that cancer tissue was less likely to extend all the way to the edges of the lycopene users' prostate glands. The pre-cancerous cells in their prostates were less abnormal looking. The PSA levels fell 20% between the start of treatment and surgery in the lycopene patients. This indicates a decrease in the size of the tumor and makes the cancer less aggressive.

A Harvard Medical School study done in 1995 examined the eating habits of 47,000 men for 6 years. Those who had at least 10 weekly servings of tomato-based foods were up to 45 % less likely to develop prostate cancer. So far the data suggests that lycopene may protect against cancer and shrink tumors of the prostate, lung, and stomach. Many more studies need be done before this hypothesis can be proven or disproved.

An associate professor of medicine at the Minneapolis Veterans Affairs Medical Center is quoted as saying: " In about 30 to 40 % of men who undergo what is thought to be successful curative surgery, there is evidence soon afterwards that the tumor has recurred or was never completely removed in the first place."

Otis Brawley, MD, an oncologist at the National Cancer Institute looked at the prostate cases and deaths in nine different regions of the US. Where there was intense testing done with PSA screening, there was a higher incidence of prostate cases found than those with the least screening. But he found that the mortality rates were almost identical for all nine regions. Leading advocates of PSA testing predict that there will be a significant fall in prostate death rates within the beginning of the next century.

A Medical Herald article ends with a quote from Gerald Chodak, MD, director of Prostate and Urology at the University of Chicago: The sad part is that the public looks to doctors for advice about this test, but the truth is that we don’t know the information. There are some potentially good things about screening, and I’m not denying them. But there are also potentially bad things that are not insignificant. Right now it’s a totally individual sort of decision."

A French Company, Genset SA announced that it has discovered a third gene that it believes if damaged or altered leads to a predisposition to develop prostate cancer. The company feels that this third gene announcement is the precursor of what ultimately will be the discovery of 10 major genes associated with the disease.

The company did not reveal the exact details, stating they were awaiting the submission of patent applications before doing so. The company's Chairman, Pascal Brandys stated that these genes were involved in about 1/3rd of the 500 French cases that they had studied. Even if all the genes involved in prostate cancer are discovered it will be many years before any drugs can be developed to remedy the problem.

The American Cancer Society and the National Comprehensive Cancer Network (a coalition of 17 cancer centers) have a combined web-site that deals with the diagnosis and treatment of prostate cancer. The URL is or


By Allan Rubin and Harold Rubin
Updated August 31, 2011

See our article
Predicting Survival After Prostate Surgery-Part II
Prostate Specific Antigen (PSA) - Part III
Prostate Specific Antigen- Part IIIa
Prostatitis- Part IV
Prostate Cancer-Colon Cancer- An Overview - Part V

Also please see: Justice Ruth Bader Ginsburg and Colon Cancer

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