Table of Contents on This Page

Most Important Thing you Need To Do

Prostate Cancer Treatment

Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer

11 Things to Know About Prostate Cancer 

Prostate Cancer Videos

Notice the major Topics covered under this category in the left hand column.  At the top of this page in blue you will see additional material that is about all treatments.

Before you make any treatment decision you MUST have your slides read by an Expert.  See Gleason Info and Partin Tables .  I cannot tell you how important this is.  We have seen men diagnosed with Gleason score  of 8 when in fact they were a Gleason score of 6.  We also have seen a Gleason score of 4 turn out to be a Gleason of 8 when checked by an expert.  As much as 50% of the local pathology doctors may be wrong.

Carcinoma of the prostate is predominantly a tumor of older men, which frequently responds to treatment when widespread and may be cured when localized. The rate of tumor growth varies from very slow to moderately rapid, and some patients may have prolonged survival even after the cancer has metastasized to distant sites such as bone. Because the median age at diagnosis is 72 years, many patients—especially those with localized tumors—may die of other illnesses without ever having suffered significant disability from the cancer. The approach to treatment is influenced by age and coexisting medical problems. Side effects of various forms of treatment should be considered in selecting appropriate management. Controversy exists in regard to the value of screening, the most appropriate staging evaluation, and the optimal treatment of each stage of the disease. 

This document is a comprehensive document of evidenced based treatments.  To read the complete document click "here"

Prostate cancer is the most common nondermatologic cancer in men. In 2007 an estimated 218,890 men were diagnosed with, and 27,050 deaths were attributed to, prostate cancer in the United States. Approximately 90 percent of men with prostate cancer have disease considered confined to the prostate gland (clinically localized disease). Reported prostate cancer incidence has increased with introduction of the prostate-specific antigen (PSA) blood test. Disease-specific mortality rates have declined, and an estimated 1.8 million men living in the United States have a diagnosis of prostate cancer.

Clinically detected prostate cancer is primarily a disease of elderly men. Prostate cancer frequently has a relatively protracted course even if left untreated, and many men die with, rather than from, prostate cancer. Largely because of widespread PSA testing, the lifetime risk of being detected with prostate cancer in the United States has nearly doubled to 20 percent. However, the risk of dying of prostate cancer has remained at approximately 3 percent. Therefore, considerable overdetection and treatment may exist.

The above is from a very well done discussion of various treatments.  In order to go there click "here".  This will take you to a "printer friendly" edition that you can print.  It is not a short article.  You do not want to miss this excellent write-up.

February 07, 2008 01:52 PM ET | Adam Voiland at

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

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.

I would like to bring to your attention a series of videos that are available on, of all places, You Tube.  Some of these are excellent by some well known doctors and very well done and some - well you will have to decide.  Again take everything said with a grain of salt until you can verify from other sources.  They all are available (lots of short videos) by clicking "here".