11 Things to Know About Prostate Cancer - On Men (usnews.com)

[Guest guest]

Summary

or recent report from US News and World Report. Important note that most recent

studies used in this report are dated 2004 based on an analysis by a PCa

advocate/survivor.

http://www.usnews.com/blogs/on-men/2008/2/7/11-things-to-know-about-prostate-cancer.html

The hard

truth, it concludes, is that reliable evidence simply doesn't exist to show

that any of these treatments are more effective at curing cancer

or less harmful than the others. Men with cancer

already know, however, that intense marketing and promotion efforts by the

organizations that make the various treatments possible—be they trade

associations, individual companies, medical associations, or individual

physicians—often tell a much rosier story. In this case, none of the

report's authors report any potential financial conflicts of interest. A rare

find, in a field notorious for them. What you need to know:

1. It

isn't clear that aggressively treating prostate

cancer

saves lives. One study shows that men under 65 who choose surgery over watchful

waiting, for example, are less likely to die or have their cancer

spread. However, since PSA tests were not used to initially detect the cancer,

it isn't known if this finding applies to men whose cancer

are detected through PSA screening (today, the vast majority of cancers are

detected this way, and it's likely that cancers found via PSA screening have

different natural progressions from those detected via rectal exam). Another

smaller study showed no difference in survival between surgery and watchful

waiting.

2. All

treatment options can result in adverse effects (primarily urinary, bowel, and

sexual), although the severity and frequency can vary between treatments. It

isn't uncommon for patients and doctors to gloss over this fact until the

treatment is finished and side effects are irreversible.

3. If you

do seek aggressive treatment, be aware that erectile dysfunction is a common

side effect. According to one reliable study, the Prostate

Cancer

Outcomes Study, 58 percent of men undergoing radical prostatectomy, 43 percent

undergoing radiation therapy, and 86 percent undergoing androgen deprivation

therapy experienced erectile dysfunction. In comparison, 33 percent of men

undergoing watchful waiting report erectile dysfunction. Some newer treatments

such as cryosurgery, intensity-modulated radiation therapy, and proton beam

therapy may result in fewer side effects, but strong evidence doesn't yet prove

this.

4.

Urinary leakage is another common side effect of prostate

cancer

treatment. The Prostate

Cancer

Outcomes Study reports that radical prostatectomy resulted in leakage 35

percent of the time; radiation therapy, 12 percent; and androgen deprivation,

11 percent.

5. Bowel

urgency is less common than other side effects. However, 3 percent of men

undergoing radiation, 3 percent undergoing androgen deprivation, and 1 percent

undergoing radical prostatectomy experience this problem.

6. A lack

of research makes it impossible to compare several newer treatments:

cryotherapy, laparoscopic (including robot-assisted) radical prostatectomy,

androgen deprivation therapy, and high-intensity ultrasound or radiation

therapy. There are also no data available from randomized trials comparing

proton beam therapy, which uses a different type of subatomic particle to kill cancer

cells from those used in other radiation therapies, with other types of

external beam radiotherapy.

7.

Clinicians are likelier to recommend procedures they have performed regardless

of tumor grades or PSA levels. In other words, urologists are likelier to

recommend surgery and radiation oncologists to recommend radiation.

8.

Urinary complications and incontinence were rarer for patients whose surgeons

performed more than 40 surgeries per year. The length of hospital stays was

also shorter for patients operated on by surgeons who frequently performed more

radical prostatectomies.

9.

Teaching hospitals had a lower rate of surgery-related complications and higher

scores for operative quality than did other hospitals. In general, hospital

readmission rates were lower in hospitals that frequently treated prostate

cancers.

10.

Adding hormone therapy prior to radical prostatectomy does not improve survival

or decrease recurrence rates, but it does increase the chance of adverse

events. Combining radiation with hormone therapy may decrease mortality. But

compared with radiation treatment alone, the combination increases the chance

of impotence and abnormal breast development.

11. More

than 90 percent of men say they would make the same treatment decision again,

regardless of the treatment received.