Common treatments for prostate cancer

This is the last of three articles on prostate cancer written by Dr. Injil Abu Bakar for The Jakarta Post.

Radical Prostatectomy

NEW YORK (JP): Men have better options for treatment today than they did only a few years ago.

Radical prostatectomy, the gold standard for surgical treatment of prostate cancer, is safer and has fewer side effects than it used to.

In this procedure, the surgeon removes the patient's prostate and sometimes the pelvic lymph nodes, through an incision in the abdomen or between the scrotum and anus. The best candidate for this surgery are men with the disease confined to the gland itself (stage A and B) who are under 70 and who are expected to live at least another 10 years.

Men have traditionally shuddered at the risk associated with radical prostatectomy -- particularly permanent impotence, which used to occur in nearly all cases. But that began to change in the early 1980s, when urologist Patrick Walsh crafted what he called an "anatomical approach" to the surgery. The procedure is performed in a way that spares the nerves controlling erections and reduces the likelihood of other serious side effects such as urinary incontinence and significant blood loss.

This approach has been adopted by many surgeons across the country and an experienced one can often preserve potency in men who had erections before the operation.

Fifty percent to 70 percent of men who undergo this treatment experience a return of potency within a year, as tiny nerve fibers -- which often stop transmitting impulses when they have been traumatized by surgery -- gradually heal. Recovery of the sexual function is largely dependent on age: the best results are achieved in men under 65.

Fortunately, the chances of death during or directly after radical prostatectomy are very small - less than 1 percent.

Radiation Therapy

Radiation to destroy cancerous cells is an alternative to surgery for treatment of early prostate cancer. It is more commonly recommended for men who are not good candidates for surgery due to poor health, or for elderly men who are not expected to live beyond 10 years. It is also a reasonable alternative for younger men who do not want surgery.

Cryotherapy

For men with early prostate cancer, another option is cryosurgery. In this procedure, liquid nitrogen is used to freeze cancerous prostate cells.

Using a transrectal ultrasound as a guide, the doctor inserts up to five metal probes into the prostate through the perineum, between the anus and scrotum. The urethra and surrounding tissues are protected by a catheter that is inserted into the penis and contains a warming solution.

Many urologists don't endorse the treatment because its efficacy has never been proven in trials comparing it to radiation therapy and radical prostatectomy.

Hormone therapy

The prognosis is not good for men with prostate cancer that has spread beyond the gland and into the lymph nodes. Patients with this stage D disease are usually offered hormonal therapy to help relieve symptoms and perhaps slow the course of the disease.

Combination therapies

A 1997 report in the New England Journal of Medicine suggests that combining radiation and hormone therapy may be more effective than radiation alone. In the study, 415 men with stage C prostate cancer (that has spread to nearby tissue but hasn't metastasized to other parts of the body) were treated with either radiation or hormone therapy and radiation. After five years, 79 percent of the men given both treatments were alive compared to 62 percent of those who only underwent radiation.

Of the surviving patients, 85 percent of those who received combined therapies had no evidence of the disease compared to 48 percent of the men who only had radiation. Additional studies on the long-term benefits of combined treatments are under way.

Any prevention?

Eating a low-fat diet makes sense for a lot of reasons, including reducing the chances of developing heart disease and certain cancers. But researchers have not yet found a powerful association between lifestyle and prostate cancer that matches the strong link between cigarette smoking and lung cancer, for example. While quitting smoking is important, it probably has little effect on a man's risk for prostate cancer.

There is increasing, but still not conclusive, evidence linking the consumption of fatty foods to prostate cancer. Some researchers suggest that a high-fat diet could be a risk factor for this disease.

In 1993, researchers at the Harvard School of Public Health published a survey of more than 51,000 American men (40 - 75 years old) showing that those who ate the most fat (89 grams daily) had nearly twice the risk for advanced prostate disease as those who consumed the least (53 grams daily).

Consumption of red meat appears to be a greater risk factor than eating other high-fat foods.

There is also evidence that a diet rich in fruit and vegetables may decrease a man's risk for prostate cancer. In 1995, a large epidemiological study by Harvard researchers found that men who ate at least 10 servings a week of tomato-based foods reduced the risk of the disease by 45 percent, while those who had between four and seven servings lowered their risk by 20 percent.

Researchers suspect the protective agent is lycopene, a carotenoid and antioxidant found mostly in tomatoes and tomato products.

One of the most interesting ongoing cancer prevention studies is examining whether finasteride might also be able to prevent prostate cancer. This nationwide trial is tracking 18,000 healthy men (55 years and over), half of whom are taking 5 milligrams of finasteride a day for seven years while others take a placebo.

What's the rationale for believing that finasteride might prevent prostate cancer? Researchers know that the drug interferes with the activity of an enzyme involved in male hormone metabolism.

Because male hormones play a strong role in prostate cancer development, physicians hope that finasteride may block some of the cellular changes that lead to cancer.

-- The writer is a general practitioner based in Denpasar, Bali. She can be contacted at injila@hotmail.com.