Prostate Cancer Treatment Update
Amazing advances have been occurring in prostate cancer detection, diagnosis, staging, and treatment, and many of these have been discussed here previously. While most cases of prostate cancer detected early are curable with appropriate treatment approaches, a small number of prostate cancer patients are not diagnosed until the cancer has already spread, and some patients develop this condition despite treatment. These cases usually reflect cancer cells that are very aggressive.
In cases where an initial biopsy shows aggressive appearing cancer cells, usually reflected in a detail of the biopsy report called the Gleason score, treatment is proportionately aggressive to try to cure the cancer. High Gleason scores don’t’ necessarily preclude any treatment options but they may be tailored to the situation.
In the unfortunate cases when treatment is not completely successful or the cancer has spread by the time it is diagnosed, there are still a number of sequential treatment approaches that are available and can be very effective. When I say sequential treatment approaches, what I mean is that the first treatment will almost always be very effective, but the effectiveness may not (and is not likely to be) permanent. However, if the effectiveness wears off, the second type of treatment is available, and even a third and fourth and perhaps more. New treatments are being proven and approved every year for prostate cancer.
The first type of treatment is usually a medicine such as Eligard that can be injected into the muscle every few months which lowers the testosterone level. This does, of course, have some side effects, and Vit. D and calcium supplements are suggested to decrease the risk of developing osteoporosis. However, this treatment will usually lower the PSA dramatically and put the cancer in remission. This response can last months, years, and sometimes many years. I have seen cases where this alone is effective for 10 years or more. So nowadays, even with aggressive prostate cancer that is not cured initially, the cancer can be managed well. If the response to medications that lower testosterone wears off, many other options are available that can still help. We will discuss those further in the next blog.