Every Day

August - December 2007 Issue

Prostate Cancer Highly Curable When Detected Early

Colleen Lawton, MD

Medical College of Wisconsin Radiation Oncologist
Named of one of the Best Doctors in America® 2006 by Best Doctors, Inc.

One man in six will get prostate cancer during his lifetime. The good news is that, through regular screening, the disease is being found earlier and the death rate for prostate cancer is going down. Early prostate cancer (cancer that is confined to the prostate gland) is very treatable. Dr. Colleen Lawton discusses treatment options for early prostate cancer.

Q. What is prostate cancer?

Prostate cancer is cancer that grows in the prostate gland, which is part of a man’s reproductive system.

Q. Are there early signs and symptoms?

No. That’s why screening for prostate cancer is so important.

Q. Why is it important to detect prostate cancer early?

The best chance for cure is when the disease is found early, before it has spread beyond the prostate. The cure rate is well above 90 percent if it’s caught early.

Beginning at age 50, men at average risk should have an annual digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test. During a DRE, a physician inserts a gloved, lubricated finger into the rectum to feel for bumps or hard areas. PSA is a substance made by cells in the prostate gland. When prostate cancer develops, the PSA level rises. Through annual screenings, we can see changes in PSA levels over time.

Men at higher risk (African-American men or men with a father, son or brother who has been diagnosed with prostate cancer) should begin prostate cancer screenings at age 40.

Q. What treatments are available for prostate cancer that is detected early?

The DRE results, PSA level and the Gleason score (a grading of the extent of the prostate cancer tissue) are used to figure out how likely it is that cancer has spread outside of the prostate. The extent of the cancer is an important factor in choosing treatment options.

There are curative and non-curative treatments for prostate cancer. Examples of non-curative treatment are:

“Watchful waiting” for men in their late 70s or early 80s, with a low risk of disease – a PSA less than 10, Gleason score of 6 or less, and T stage of T2a or less. T stage indicates the extent to which cancer has spread. In a case like this, we continue screening every three to six months. If the disease progresses, we then begin treatment.
Hormone therapy – a treatment that lowers the “male” hormone testosterone and can suppress the cancer for a period of time but cannot cure it.

Many types of curative treatments are available. These include:

Intensity-modulated radiotherapy (IMRT) — a process that uses computers to plan the precise delivery of dozens of tiny, thin radiation beams (rather than a single large radiation beam) to the tumor; the computer determines the best way to deliver treatment by “modulating” the intensity of each radiation beam
Standard brachytherapy — radioactive “seeds” implanted in the prostate gland in an outpatient surgical procedure; the seeds give off radiation at a low dose rate over several months and remain in the prostate permanently
High-dose-rate brachytherapy — a number of catheters (tubes) are placed into and around the tumor, and a high dose of radiation is delivered through the catheters; the entire treatment takes days instead of weeks
Robotic-assisted laparoscopic radical prostatectomy — minimally invasive (laparoscopic) surgery to remove the prostate gland; to perform the surgery, the surgeon manipulates four computerized robotic arms
Nerve-sparing robotic-assisted laparoscopic radical prostatectomy — minimally invasive (laparoscopic) surgery to remove the prostate gland while sparing the nerves that control a man’s ability to have an erection
Open prostatectomy — open (non-laparoscopic) surgery to remove the prostate gland using a standard incision in the lower abdomen
Nerve-sparing open prostatectomy — open (non-laparoscopic) surgery that uses a standard incision to remove the prostate gland while sparing the nerves that control a man’s ability to have an erection
Cyrosurgery — uses an instrument to freeze and destroy cancer cells in the prostate gland

Q. Are there more treatment options when prostate cancer is detected early?

Yes, more options are available to treat early prostate cancer. However, once the cancer grows outside the outer rim of the prostate and into nearby tissue (locally advanced cancer), surgery and brachytherapy are no longer good treatment options.

Q. What should a man look for when choosing a physician to treat prostate cancer?

He should look for a physician who has specialty training in oncology, a surgeon who is trained in surgical oncology and a radiation oncologist with expertise in prostate cancer radiation therapy.

Perhaps the biggest challenge men face is receiving information on all of their options. For example, if he meets with only a surgeon, he may only learn about a surgical treatment for his disease. At Froedtert & the Medical College of Wisconsin, team members work together to offer all appropriate treatment options to each patient. Our goal is to encourage men to think about all of these options before they make a treatment decision.

Through our Second Opinion Program, men are able to consult with top prostate cancer experts to ensure their diagnosis is correct, that they’re aware of every treatment option, and that they’ve made decisions based on what’s best for them.

Source: Every Day

Date: Aug - Dec 2007 Issue