- Thursday, August 24, 2017
Prostate Cancer and Modern Medicine
By: Dr. Joelle Hamilton
Prostate cancer is the second most common cancer diagnosed in American men and the second leading cause of cancer death. While a majority of men will be diagnosed after the age of 65, younger men do need to consider screening for prostate cancer, especially if risk factors are present such as African American heritage or a family history of prostate cancer.
Fortunately, many men are cured of prostate cancer with surgery or radiation. However, some men may be diagnosed when the cancer has spread beyond the prostate or have a recurrence of previously treated prostate cancer. Advanced prostate cancer, when the cancer has spread beyond the prostate or has recurred after treatment, has been revolutionized during the last decade.
I remember 40 years ago when I was a child, my elderly grandfather was diagnosed with advanced prostate cancer, which had already spread to the bones. Screening with blood tests was not available then. Regular examinations of the prostate by a physician was not part of routine care. Only when he developed pain related to spread of the cancer to the bones was his diagnosis made. Treatment consisted of medicines to help his pain and consideration of removing testosterone from the body through a procedure called orchiectomy. Unfortunately, he died within a few months.
Fortunately, prostate cancer knowledge and treatment has advanced since the time my grandfather was a patient. Today, prostate cancer has been shown to be a complex disease which is categorized by your doctor as localized, metastatic, hormone sensitive, hormone resistant, and biochemical relapse (post treatment PSA rise without evidence of other disease). And as complex as the many categories of prostate cancer are, the options for treatment are even more complex.
At Urology Centers of Alabama, we bring together all the doctors who care for advanced prostate cancer. With a multi-disciplinary team of a Urologist, Radiation Oncologist, and Medical Oncologist, we manage all facets of your prostate cancer. Treatment options can improve your quality of life as well as extend your life. Hormone therapy, or androgen deprivation therapy, is the backbone of advanced prostate cancer. As the testosterone stimulates the prostate and prostate cancer, removing testosterone from the body treats the cancer. This can be accomplished by a variety of means including injections, surgery (removal of the testicles), and sometimes pills. Given the many benefits and risks of decreasing testosterone in a man, this decision is carefully considered among you and all members of your healthcare team.
When the cancer progresses, despite decreasing the testosterone levels, the cancer has become hormone resistant. At this point, several different treatment options can improve your quality of life and survival. Immunotherapy (Provenge or Sipleucel-T) harnesses the body’s own immune system to fight the cancer similar to how vaccination primes the body to fight infection. Bone targeted treatment helps build back the bones in the setting of hormone deprivation and bone metastasis (spread to the bone). Radiopharmaceuticals (Xofigo) is a radioactive particle that is injected into the vein under the supervision of the radiation oncologist with the goal of the radioactive particle going specifically to the cancer in the bone. Bone resorptive agents is a class of medicines which decreases pain, fracture, and the need for radiation to the bones. Pills which further block the testosterone have been shown to improve both survival and quality of life while allowing you to take your treatment safely and conveniently at home. Finally, in our infusion suite, we administer chemotherapy into the vein for newly diagnosed advanced prostate cancer or patients whose disease has progressed on the above treatments.
Our goal at Urology Centers of Alabama is to treat the whole person. Spiritual well-being, emotional health, nutrition, and symptom control all impact the success of prostate cancer treatment. In addition, we know that maintaining close contact with patients on active treatment allows us to address side effects or symptoms of cancer quickly, before worsening, allowing men to stay on treatment longer and live longer. That can only be accomplished in a setting where the doctors and nurses are approachable, available, and compassionate. This can be a hard road – we are here to walk with you the entire way!