Medical Essay Prostate health Supplement to MAYO CLINIC HEALTH LETTER

Medical Essay
Supplement to MAYO CLINIC HEALTH LETTER
JUNE 2005
Prostate health
Early detection, informed choices
Every time you have coffee with the guys, the three P’s always seem to come up: politics, putting greens … and
prostate. And everyone except you has had a prostate problem. Your prostate is fine. So the guys give you a ribbing. It’s just a matter of time, they say, before your prostate starts giving you trouble, too.
All kidding aside, they may be right. Although you’re not destined to have prostate trouble, some form of
prostate disease affects more than 50 percent of all men. And, prostate problems become more common with age.
Three main types of prostate disease are inflammation, enlargement and cancer of the prostate gland. Although
annoying and sometimes painful, inflammation and enlargement generally aren’t life-threatening. However,
prostate cancer can be deadly.
In addition, treating prostate cancer can result in troubling side effects — such as impaired bladder control
(incontinence) and an inability to have an erection (impotence).
If detected early, prostate cancer usually can be successfully treated. Improvements continue to be made in
doctors’ ability to detect and diagnose prostate problems
at an early stage. Advances in drugs, surgical techniques,
radiation therapy and hormone therapy are improving outcomes and reducing the risks of incontinence and impotence.
You can help minimize prostate problems by:
■ Having regular prostate exams if you’re 50 or older
■ Having your prostate checked by your doctor if you
experience certain signs and symptoms
■ Understanding your screening and treatment options
and, if necessary, choosing a treatment that you and your
doctor feel is best
The odds may be high that you’ll have some kind of
prostate disease in your lifetime. However, knowing the
facts about prostate problems can help put the odds in your
favor with early detection and successful treatment.
The healthy prostate
The prostate is located just below your bladder and surrounds the urethra, the tube that drains your bladder.
Normally, an adult prostate is about the size of a walnut. Around age 45, the prostate often starts to grow. The
prostate isn’t a part of your urinary system, but it’s important to urinary health due to its location. If prostate tissue
swells or grows, it can crowd the urethra and make it difficult to urinate.
Bothersome or even painful signs and symptoms will
often alert you to a prostate problem — especially prostate
inflammation or enlargement. These signs and symptoms,
which may also be caused by another condition such as
a urinary infection, may include:
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Medical Essay
Pain or a burning sensation while urinating
Painful ejaculation
■ Persistent, dull pain in your pelvis, lower back, hips or upper thighs
■ Frequent need to urinate, especially at night
■ A weak urinary stream
■ Difficulty starting urination
■ Interrupted flow of urine stream
■ Feeling as if your bladder isn’t empty, even after you’ve urinated
■ Blood in your urine or semen
■ Pain or swelling in the testicles
Although some of these signs and symptoms may simply feel like a
mild annoyance that you can tolerate, don’t put off a visit to your doctor. A prompt evaluation is key to the early detection of a potential problem and improved chances of successful treatment.
In the case of prostate cancer, being alert to signs and symptoms of
prostate disease often isn’t enough. The American Urological Association recommends a yearly prostate exam for men starting at age 50. Your
doctor may recommend starting yearly exams sooner, such as age 40,
if you have certain risk factors, such as having a family history of prostate
cancer or being of African descent. That’s because prostate cancer often
doesn’t produce signs and symptoms in its early stages. It’s not until later,
when the cancer has spread beyond the prostate and is much more
difficult to treat successfully, that signs and symptoms appear.
■
Prevention
You may be able to reduce
your risk of developing prostate
cancer by:
■ Eating well — Certain
plant-based products appear to
reduce the risk of prostate
cancer. These include tomatoes
and tomato products, soy products, green tea, garlic and cruciferous vegetables, such as
broccoli, cabbage, cauliflower
and bok choy. There’s some
evidence that a diet high in fat
or total calories may increase
prostate cancer risk.
■ Staying active — Regular
exercise may reduce your risk
of developing cancer, including
prostate cancer.
■ Not smoking — Cigarette
smoking may increase prostate
cancer risk in younger men.
■ Avoiding supplemental
hormones — Large doses of the
nutritional supplement dehydroepiandrosterone (DHEA),
often touted to slow aging,
burn fat and build muscle, may
promote prostate cancer
development. It may also
aggravate prostate enlargement.
■ Being cautious with
sexual activity — Men with a
history of sexually transmitted
diseases or men who’ve had
numerous sexual partners may
have an increased risk of
prostate cancer.
■
Tests your doctor may consider
A prostate exam may include the following tests:
■ Digital rectal exam — Your doctor inserts a gloved, lubricated
finger into your rectum to check your prostate, which is adjacent to your
rectum. If your doctor finds any abnormalities in the texture, shape or
size of the gland, more tests may be warranted to determine the cause.
■ Prostate-specific antigen (PSA) test — This test looks for PSA in
your blood. PSA is a substance naturally produced in your prostate gland.
Normally, a small amount of PSA enters your bloodstream. If a higher
amount is found, it may be an early indicator of prostate disease.
The PSA test has been controversial for some time. Although PSA testing has some pitfalls, Mayo Clinic prostate cancer specialists support
PSA testing — along with digital rectal exam — as the best screening
tools available for detecting early prostate cancer. In addition, several
refinements in the PSA test are helping to more accurately identify people with prostate cancer. One refinement involves using an age-based
scale to identify above-normal PSA levels. That’s because PSA levels tend
to increase with age, even if your prostate is healthy. Another refinement,
called the free-PSA test, divides the PSA in your bloodstream into two
kinds — “bound” PSA is attached to certain blood proteins and “free”
PSA isn’t. Prostate cancer is more likely to produce bound PSA. Therefore, a higher amount of bound PSA in comparison to free PSA indicates
an increased likelihood of prostate cancer.
■ Urine test — This looks for abnormalities that may help identify
a potential problem with your prostate or with your urinary tract.
■ Ultrasound — If tests raise concerns about prostate problems, your
doctor may want to obtain images of your prostate using transrectal ultra-
Medical Essay
Research
Molecular and genetic science
hold promise for more accurate
diagnosis and targeted treatments. Researchers are testing
applications that may lead to:
■ Screening tests that
would more accurately indicate the presence or recurrence
of cancer than does the prostate-specific antigen (PSA) test.
■ Identification of a gene or
genes that play a role in prostate cancer development. Men
who carried these genes could
be more closely monitored.
■ Development of modified
genes that could cause prostate
cancer cells to self-destruct or
alter prostate cancer cells so
that they’re more vulnerable to
standard chemotherapy or to
attack from your own immune
system. Genetic material could
also be used to deliver a
chemotherapy drug to cancer
cells elsewhere in the body.
Retrograde ejaculation
It’s common for men who have
undergone transurethral resection of the prostate (TURP) to
have retrograde ejaculation.
This is a typically permanent
side effect in which semen flows
backward into the bladder instead of out through the penis.
Men can still have an orgasm,
but may have problems with
fertility, if this is a concern.
Retrograde ejaculation can
also occur with transurethral
incision of the prostate (TUIP)
and less commonly with photoselective vaporization of the
prostate (PVP).
3
sound. With this type of ultrasound, a small probe is inserted into your
rectum. Sound waves from the probe are converted to a video image for
detection of abnormal nodules.
Inflammation
Prostatitis is a general term for inflammation of the prostate gland.
Prostatitis is common and occurs most often in men ages 30 to 50, but
it can affect older men, too.
The three types of prostatitis include:
■ Acute bacterial — This is the least common and most severe form.
It often produces sudden signs and symptoms of prostate disease and
may cause fever, chills or a flu-like feeling. Without immediate care,
acute bacterial prostatitis can result in serious problems, including an
inability to urinate. Antibiotics usually clear up the infection.
■ Chronic bacterial — This also results from a bacterial infection.
Signs and symptoms are similar to acute bacterial prostatitis, but they’re
often milder and may develop more slowly. Chronic bacterial prostatitis is more resistant to treatment using antibiotics. Treatment may take
longer and may not be as effective. Still, signs and symptoms may be
controlled with long-term, low-dose antibiotic therapy.
■ Chronic nonbacterial — This is the most common type of prostatitis and is the most difficult to diagnose and treat. Signs and symptoms
are almost identical to those of chronic bacterial prostatitis, but bacteria aren’t detectable in urine or prostate fluid. It’s not known what causes chronic nonbacterial prostatitis. Suspected causes include bicycling,
jogging, occupations that subject the prostate to vibration, and tightening pelvic floor muscles due to stress and anxiety.
Treatment for persistent prostatitis mainly focuses on relieving signs
and symptoms. Your doctor may prescribe an alpha blocker drug such
as doxazosin (Cardura, others), tamsulosin (Flomax) or alfuzosin (Uroxatral). These can help improve urine flow by relaxing smooth muscle in
the prostate and bladder neck. Nonprescription pain relievers may
help with pain and discomfort. Even if your doctor suspects nonbacterial prostatitis, an antibiotic may be prescribed to see if symptoms improve.
Stretching, stress-reduction techniques and heat, from a low electrical current applied to your pelvic region or from sitting in a warm bath,
may help loosen and relax pelvic muscles. Some doctors may recommend massaging the prostate gland to relieve gland congestion and to
unplug tiny gland ducts of inflammatory byproducts caused by bacteria.
Enlargement
With age, many men develop an enlarged prostate, a condition known
as benign prostatic hyperplasia (BPH). An enlarged prostate isn’t a health
problem unless prostate growth constricts your urethra, causing trouble with urination.
If your doctor suspects BPH after a basic prostate exam, additional
tests may be performed to confirm a diagnosis and assess its severity (see
our August 2004 article “Enlarged prostate”).
Treatment options for BPH can vary. Certain factors — such as the
severity of your urinary problems, the size of your enlarged prostate, your
age and health, and concerns that you may have over the potential for
4
Medical Essay
Choosing cancer treatment
If you have early-stage prostate
cancer, you’ll likely have more than
one treatment option.
Making a choice can be difficult
since — in general — there appear to
be only slight differences in the side
effects and outcomes of surgical prostate removal, external beam radiation
and brachytherapy.
No study has definitively compared early-stage prostate cancer
treatments side by side. Such a study
would likely help doctors determine
which type of treatments work best in
situations where there’s no clear
advantage in choosing one treatment
over another. Until such a study is
completed, comparing side effects of
treatments using this chart may be
one way to help you make a decision.
Adjusting to BPH
Minimizing the impact that
benign prostatic hyperplasia
(BPH) has on your urination
patterns may include:
■ Not drinking fluid for two
or three hours before bedtime.
■ Trying to empty your
bladder completely each time
you urinate.
■ Limiting alcohol and cutting back on caffeinated drinks.
■ Avoiding nonprescription
antihistamines and decongestants. They can cause the muscle that controls urine flow to
tighten.
■ Staying active. Urine is
retained when you’re sedentary.
■ Staying warm. Being cold
can lead to urine retention.
Surgical
prostate
removal
Bladder problems
Rectal or bowel problem
Early incontinence is relatively common after surgery. However, most
men report no significant problems
two years after surgery.
Rare.
External Signs and symptoms of bladder
beam
irritation — such as a burning sensaradiation tion during urination, the constant
urge to urinate, and bleeding — may
develop during treatment but usually
disappear within weeks after treatment
is completed. Incontinence is rare.
Signs and symptoms, suc
ing sensation around the
constant urge to have a b
ment, or bleeding, may o
treatment but most go aw
therapy. More-serious, lo
bowel problems are rare.
Radioactive
seed
therapy
Urgency to have a bowel
may occur after therapy i
people, but is nearly alw
within six to 12 months.
Incontinence can occur, but is unlikely to persist for longer than a year.
Signs and symptoms of bladder irritation are more common during and
after treatment than with external
radiation and usually improve or
disappear.
problems such as ejaculation or impotence — may all have an impact
on which treatment option is best for you. Options include:
■ Watchful waiting — If your urinary problems are mild, your doctor may not recommend treatment. Signs and symptoms may stay the
same or only slowly progress in many men with mild BPH. A few simple lifestyle changes may help (see “Adjusting to BPH,” this page).
Still, it’s important for you and your doctor to keep tabs on your problems. Long-standing bladder obstruction due to BPH can lead to or mask
potentially irreversible bladder damage due to loss of bladder muscle
tone. Bladder infections and kidney damage may also result.
■ Oral medications — This is the most common way to control mild
to moderate urinary problems associated with BPH. Your doctor may
prescribe a drug in the alpha blocker class. Drugs in this class are used
for relieving signs and symptoms. Two other drugs — finasteride (Proscar)
and dutasteride (Avodart) — are also used. (See our July 2003 article
“Drug available to treat enlarged prostate.”) Over time, these can shrink
an enlarged prostate.
Recently, an important study found that taking the alpha blocker doxazosin in combination with finasteride provided better long-lasting symptom relief and significantly reduced the risk of BPH progression.
■ Minimally invasive therapy — Several therapies use heat energy
— including microwave and radio waves — to destroy prostate tissue.
Most of these procedures involve delivering heat into the prostate through
a catheter or an instrument inserted into the urethra. They’re often done
on an outpatient basis and generally cause fewer side effects than surgery.
Medical Essay
ms
ch as a burnanus, the
bowel moveoccur during
way after
ng-term
.
l movement
in some
ays gone
5
Impotence*
Other pros
Other cons
Varies widely. Roughly 50 percent
risk of impotence following the
procedure. If under age 60, the
risk may be lower. If over 70, the
risk may be higher.
Lymph nodes and
prostate can be more
closely analyzed to
better determine cancer
aggressiveness or spread.
Requires hospital stay and recovery
period. Urinary catheter usually needed for two to three weeks. Regaining
full bladder control may take weeks or
months. Anesthesia is required.
Varies. Initially causes a low rate
of impotence. Five years after
treatment, reports indicate that
impotence occurs in 10 percent
to 50 percent of men.
An outpatient procedure,
but requires numerous,
short visits to radiation
treatment center.
Unable to further analyze cancer cells
in prostate or look for cancer spread in
lymph nodes.
Results are similar to those of
external beam radiation.
Can be implanted in a
single, outpatient procedure.
Unable to further analyze cancer cells
in prostate or look for cancer spread in
lymph nodes. Anesthesia is required.
*Measuring impotence risk is a controversial area because so many factors — related to the procedure
or not — can contribute to impotence. Factors include age, previous erectile problems, sexual activity
levels, the experience level of the surgeon performing your procedure, other diseases and your relationship with your sexual partner.
Newer laser procedures eliminate or reduce
many potential downsides of previous laser
procedures, such as slower symptom relief
and prolonged use of a urinary catheter. The
most commonly used procedure is photoselective vaporization of the prostate (PVP).
However, symptom relief with these procedures typically occurs at a
slower pace and isn’t as complete as with traditional surgery.
For men who have urine blockage but aren’t healthy enough to undergo even minimally invasive therapy, a tiny metal coil (stent) can be inserted into the urethra to assist urination. Stents don’t always work and can
cause complications, but for some are an alternative to catheterization.
■ Laser therapy — Newer laser procedures eliminate or reduce many
potential downsides of previous laser procedures, such as slower symptom relief and prolonged use of a urinary catheter. The most commonly used procedure is photoselective vaporization of the prostate (PVP),
which was developed in large part by Mayo Clinic doctors. A less widely used new procedure is called holmium laser ablation of the prostate
(HoLAP). These laser procedures vaporize or cut out prostate tissue
(see our January 2004 article “Enlarged prostate”). So far, they’ve been
shown to combine the benefits of minimally invasive treatment with minimal catheter need and, often, immediate improvement in urine flow.
Still, it may take several months to reach the maximum improvement
in urine flow that these procedures can provide. A five-year follow-up
study of 84 men who had PVP done showed continued effectiveness
of the treatment and minimal side effects.
■ Surgery — Medications and minimally invasive therapies have
made surgery less common. It remains a very effective treatment option,
but it’s typically reserved for men with more severe BPH problems.
The most common surgical treatment for BPH — transurethral resection of the prostate (TURP) — involves inserting a narrow device (resec-
6
Handling side effects
For some men, the thought of
becoming impotent or incontinent from prostate cancer treatment is as daunting as the
disease. Fortunately, these side
effects aren’t always permanent. And, whether temporary
or permanent, therapies are
available to help.
Treatment recommendations
for urinary incontinence depend on the type of incontinence you have, how severe it
is and the chances that it will
naturally improve over time.
Options include behavior
modifications — such as going
to the bathroom at set times
rather than according to urges
— medications, catheters and
exercises to strengthen your
pelvic muscles.
If leakage problems have
continued for at least a year
without improvement, your
doctor may suggest surgery.
Several procedures are available, including implanting an
artificial sphincter around your
urethra or injecting a bulking
substance into the lining of
your urethra to thicken tissues.
Among the ways to treat
impotence are the oral drugs
sildenafil (Viagra), tadalafil
(Cialis) and vardenafil (Levitra).
Alternatives include a
suppository that you insert into
the tip of your penis, a penile
drug injection and vacuum
devices that assist in achieving
erection. If other treatments
fail, the final option includes
surgical penile implants that
can create an erection.
Medical Essay
toscope) through the urethra to the prostate area. Excess prostate tissue
is trimmed away using tools that operate through the resectoscope.
TURP is done under general anesthesia or with a spinal block that
anesthetizes you from the waist down. It may be done as an outpatient
procedure, but typically results in a hospital stay of one day. Although
TURP is effective at relieving symptoms within a few weeks, you will
likely need to have a catheter remain in your bladder for a few days to
drain your urine and you may see some blood in your urine. In a few
instances, TURP can cause impotence or incontinence. Should incontinence occur, it’s often temporary.
Transurethral incision of the prostate (TUIP) is a surgical procedure
in which one or two small cuts are made to your prostate. The cuts
help enlarge the opening of your urethra, making it easier to urinate. This
procedure causes fewer side effects than do other surgical therapies
for BPH and doesn’t require a hospital stay, but it may be less effective
and may need to be repeated.
Open surgery to fully or partially remove the prostate may be used
if you have bladder damage, an excessively large prostate or other complicating factors, such as stones in your bladder. With these procedures,
your surgeon makes an incision in your lower abdomen to reach the
prostate. In terms of relieving BPH symptoms, open surgery is very effective. However, the risk of side effects — which are similar to those that
can occur with TURP — is greater and a one- to three-day hospital
stay is usually required.
Cancer
Prostate cancer is the second most common type of cancer in men.
About one in six men will receive a prostate cancer diagnosis in his lifetime. The majority of prostate cancer diagnoses involve a slow-growing type of cancer. With regular screening, many of these cancers are
detected before they have a chance to spread beyond the prostate gland.
If your doctor suspects cancer after a basic prostate exam, small
tissue samples will likely be taken for laboratory analysis. This procedure, called a biopsy, involves inserting — guided by ultrasound imaging — a hollow needle into your prostate to retrieve tiny sections of
tissue. Prostate biopsy typically is done using local anesthesia.
If a biopsy confirms the presence of cancer, doctors try to determine
how aggressive the cancer is (grade) and if it has spread beyond your
prostate (stage).
Doctors may be able to predict the stage of your prostate cancer based
on your prostate exam and a combination of your PSA level and biopsy results. Your doctor may also want additional tests. These tests, which
may include a bone scan, chest X-ray, magnetic resonance imaging (MRI)
or a computerized tomography (CT) scan, are used to look for the spread
of prostate cancer elsewhere in your body.
The grade and stage of your prostate cancer and your general health
are key factors in determining a treatment plan. The main treatment
options for prostate cancer in these early stages include:
Watchful waiting — Watchful waiting is an option that’s more likely to be chosen by men in their 70s and 80s. It may take 10 or more years
for slow-growing cancer to spread and cause problems. Depending on
Medical Essay
Transurethral resection of the prostate (TURP)
involves inserting a narrow device (resectoscope) through the urethra. Excess prostate
tissue is trimmed away using tools that operate through the resectoscope.
Treating prostate cancer may involve surgical
removal of the prostate. New techniques usually allow surgeons to spare muscles and
nerves near the prostate that control urination and sexual function.
In external beam radiation therapy, a machine
produces a radiation beam that’s focused on
the tissues to be treated.
7
your health, that may be longer than your life expectancy. In addition,
the stress of treatment could pose more risks than the cancer.
Watchful waiting means you stay alert to any new signs or symptoms. Your doctor will likely recommend blood tests and a rectal prostate
exam every six months or so. Your doctor may also order occasional
biopsies. If the cancer becomes more aggressive and starts to spread
quickly, treatment can begin.
The downside of watchful waiting is the chance that your cancer will
become more aggressive, and possibly require more extensive treatment
than if it had been treated earlier. One study showed that this occurred
in about 13 percent of men who chose watchful waiting.
Surgical prostate removal (radical prostatectomy) — The most common form of radical prostatectomy is retropubic surgery. In it, an incision is made in your lower abdomen. Your surgeon may first remove
lymph nodes near your prostate to have them quickly analyzed in the
laboratory. This procedure is often used to confirm that cancer hasn’t
spread beyond your prostate gland. The procedure is done under general anesthesia or with a spinal block. It often requires a one- to threeday hospital stay and a three- to five-week recovery.
New techniques usually allow surgeons to spare muscles and nerves
near the prostate that control urination and sexual function. This has
reduced the likelihood of developing a bladder problem or erectile dysfunction. However, erectile dysfunction remains a common problem.
Minimally invasive surgical techniques involve removing the prostate
using pencil-thin instruments (endoscopes) that are inserted into the
body through several small incisions in the abdomen. This procedure
has also been done with the use of robotic assistance devices. This
approach is being used in many hospitals, but whether this is better than
the traditional radical prostatectomy is still unknown.
Radiation therapy — This is an effective alternative to surgery. Its
main advantage is that it allows you to avoid the stresses of surgery. Side
effects may include rectal and urinary problems and the eventual development of erectile dysfunction. The risk of these side effects has declined
in the past decade due to advances in technology to target radiation,
and better selection of men who would most likely benefit from the procedure. Radiation delivery methods include:
■ External beam therapy — This is the most commonly used method.
In it, a machine produces a radiation beam that’s focused on the tissues
to be treated. Identifying the precise area to focus the radiation may
involve a number of techniques. Three-dimensional scans or ultrasound
imaging may be used to show the location of the prostate and identify
angles in which radiation beams are least likely to hit surrounding organs.
A newer procedure involves implanting into the prostate tiny metallic
pellets that can be detected and targeted by the radiation machine.
External beam treatments are generally given five days a week for
about six to eight weeks. High-powered X-rays are the most common
form of radiation used. However, a newer form of the therapy uses
protons instead of X-rays to kill the cancer. Protons travel through noncancerous tissue and deposit their radiation dose in the targeted area.
This form of radiation is under study at a few medical centers, and it’s
anticipated that use of this technique will increase in coming years.
8
Medical Essay
When cancer has spread
If your cancer has spread
beyond your prostate gland,
curing it is more difficult.
However, certain treatments
can help control the cancer.
The most common treatment involves using drugs to
stop your body from producing
most male sex hormones — the
main hormone being testosterone — or to block hormones
from getting into cancer cells.
(See our August 2003 article
“Prostate cancer drugs.”)
Drugs that stop your testicles from receiving signals to
produce testosterone are known
as luteinizing hormone-releasing hormone (LH-RH) agonists.
These include goserelin (Zoladex) and leuprolide (Lupron),
which are injected once every
one to four months, and a leuprolide (Viadur) that’s surgically
implanted once a year. Antiandrogens — which include
bicalutamide (Casodex), flutamide (Eulexin, others) and nilutamide (Nilandron) — are in
another class of medications
often used in combination with
LH-RH agonists. These drugs
work by blocking testosterone
receptors in your cancer cells.
Surgically removing the
testicles is another way to diminish testosterone production.
This was once the standard
treatment for advanced prostate
cancer, but hormone-blocking
drugs have greatly reduced the
need for this procedure. When
advanced cancer isn’t responding to other treatment, chemotherapy may be an option.
Recycled paper
■ Radioactive seeds (brachytherapy) — With this type of radiation therapy, rice-sized radioactive
seeds are implanted into your prostate. The seeds are precisely placed
with the aid of ultrasound imaging
and can deliver about twice the
radiation dose of external beam
therapy. The radiation emitted from
Tumor
the seeds only extends a few milRadioactive
seeds
limeters beyond their location. The
most common type of seeds lose In brachytherapy, strands of radioactive
their radioactivity within about a seeds are implanted into your prostate.
year and aren’t removed.
Prostate freezing (cryotherapy) — This newer procedure involves
inserting thin metal rods into your prostate to freeze cancerous cells and
cause them to rupture and die.
Combination therapies — Combining treatment methods in the hope
of achieving better results has been a relatively recent development in
treating prostate cancers of many grades and stages, particularly those
that are more advanced than average. Combinations may include:
■ External beam radiation in addition to brachytherapy — In some
men with more aggressive cancer confined to the prostate, but more
commonly in men with cancer slightly beyond the prostate, external radiation may be used to boost the dose of seed radiation or to direct radiation to areas not receiving a full dose of radioactivity from seeds.
■ Surgery to remove your prostate followed by external beam radiation — External beam radiation may be used to treat the area around
the removed prostate site when microscopic examination of prostate tissue indicates that small numbers of cancer cells may have been left
behind after surgery. In addition, it may be used if your PSA level rises
some months or years after surgery.
■ External beam radiation and hormone therapy to reduce testosterone levels — Hormone therapy can cause large tumors to shrink. This
may make it easier to destroy the tumor with radiation. After radiation,
hormone therapy can help kill stray cancer cells left behind at the tumor
site. Several recent studies have shown this therapy combination to
significantly increase survival of men with medium- to high-risk prostate
cancer. Some of these cancers had advanced slightly beyond the prostate.
■ Brachytherapy and hormone therapy — In addition to killing
prostate cancer cells and lowering your PSA level, shrinking a large
prostate with hormone therapy may make it easier to implant radioactive seeds. In this approach, hormone therapy is given for several months
before brachytherapy. An added benefit may be improved urine flow.
Doing your part
Treatments for prostate disease are advancing. Doctors’ ability to
detect prostate disease in its earliest stages is good and is improving.
Doing your part includes taking advantage of these advances. ❒
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