Treating and Diagnosing Prostate Cancer


Diagnosis

Blood tests for prostate cancer in addition to PSA are available that improve the accuracy and can sometimes be used to avoid repeat biopsy. A urine test for prostate cancer, PC3, is now available and promises to be more sensitive and specific than PSA.

Transrectal ultrasound and multiple-core needle biopsy with local nerve block improve the accuracy of biopsy and markedly reduce the discomfort.

Treatment

Surgery: Nerve-sparing radical prostatectomy is the gold standard for management of prostate cancer confined to the gland in men who have a life expectancy of 15 or more years. Dr. Lamm uses the "mini-lap" approach when possible, avoiding the large and more painful incision. Laparoscopic prostatectomy is also available. With the laparoscopic procedure the incisions are very small and hospital stay is reduced from two days to one.

What to Expect After Your Prostatectomy

Robotic Surgery: With robotic surgery people are able to return to full activity sooner and urinary continence returns, if lost, more quickly. Visibility is improved and it is hoped that nerve sparing for potency, when indicated, will be better, but this has not been proven. We also hope that improved visibility will improve the completeness of cancer removal, but this too remains to be proven...continue

Radiation: For patients who have a shorter life expectancy or have very low risk disease, radiation therapy is available. Brachytherapy, or "radioactive seeds" can be very effective and is done as a same-day surgical procedure. Patients with a large prostate and difficulty voiding are not good candidates for seeds because there is a high risk of incontinence after the procedure.

For patients who need external beam radiation therapy we recommend and refer specifically to units that have Intensity Modulated Radiation Therapy (IMRT). With this technique higher doses of radiation can be used to improve the results as well as reduce side effects by avoiding radiation of normal tissue.

Other Therapies: For patients with advanced disease or PSA failure following prostatectomy or radiation therapy, Dr. Lamm has an innovative approach to hormone therapy, chemotherapy, immunotherapy and complimentary therapy that is designed to maximize efficacy and minimize side effects.

A recent patient comes to mind who was referred to Hospice after failing hormone therapy and the latest chemotherapy. Not ready to throw in the towel, we changed his hormone therapy, started him on Oncovite , which now contains optimal doses of Vitamin D, and started Candesartan 4mg daily. One month later he was feeling better, has had no medication side effects, and has had over a 200 point drop in his PSA.

BCG, in a controlled trial, significantly prolonged survival in patients who were had failed hormone therapy. It is not approved for prostate cancer, but may benefit some patients. Apatone, a promising new non-toxic oral treatment that uses two molecules to kill cancer cells will soon be available. Additional studies of immunotherapy and innovative chemotherapy and hormone therapy are planned.

Supportive/adjuvant care to prevent bone fractures using Zometa by intravenous infusion is available.

More prostate cancer treatment information

Created: 3/15/2005 | Updated: 3/28/2006