Conventional Treatment of Prostate Cancer
As I implied last time, for stages A and B of prostate cancer, when the cancer is confined to the prostate gland, a radical prostatectomy is most often recommended by urologists. This surgery involves the removal of the entire prostate gland and capsule and surrounding structures, such as the seminal vesicles. The surgery results in considerable pain post-operatively, as well as many complications. Most patients will be permanently sexually impotent following the surgery and 5 to 30% will suffer from some degree of urinary incontinence. Recovery time, which is rarely complete, takes at least 6 months.
Although a high cure rate is claimed by the urologists, especially for stage A, the question becomes what would be the survival rate of these patients if they had no procedure whatsoever? The answer is not clear. It is difficult to evaluate the effects of conventional treatment for prostate cancer for the following reasons. 1) It is usually a slow growing disease and therefore it takes many years to evaluate treatment results. 2) The disease is often dormant for years and may never manifest itself during the life of the patient, who may die from an entirely unrelated cause. 3) Today the diagnosis is made more often and earlier because of the PSA test, which was introduced only a few years ago, prostate ultrasound procedures and multiple biopsies. 4) Both radical prostatectomy and external beam radiation, the two most recommended procedures have many side effects and result frequently in a poor quality of life after the procedures. And 5) 25 to 50% of clinically diagnosed stages A, B and C actually turn out to be stage D after the procedure is done. Surgery or radiation are useless for stage D. All of this has led the well known urologist from Sloan-Kettering, Dr. Willet F. Whitmore to ask the question: " Is cure possible in those for whom it is necessary and is cure necessary in those for whom it is possible?"
External beam radiation is usually recommended for stage A and B when the patient is elderly or frail or would be a poor surgical risk. During and following this treatment at least 30 to 50% of patients experience inflammation of the bladder or rectum with diarrhea and other bowel symptoms, urinary retention and swelling of the penis and scrotum. Long term effects include sexual impotence in 40 to 75 per cent and a continuation of the acute side effects in less than 10 per cent of the patients. The problems with surgery and radiation have led to alternative conventional approaches.
The conventional treatment usually recommended for stage A or B prostate cancer is usually either a radical prostatectomy or external beam radiation. The appropriate conventional treatment for stage C or D is usually an anti-hormonal treatment. As early as 1941, Dr. Huggins found that when the supply of the male hormone testosterone available to the prostate is reduced or eliminated, prostate cancer would regress, often dramatically. This was done either by surgically removing the testes of the patient, which greatly reduced available testosterone, or by giving synthetic estrogen drugs, such as DES. This latter treatment would inhibit the pituitary from secreting hormones necessary for production of testosterone from the testes. Because of the significant cardiovascular side effects associated with synthetic estrogen drugs, new drugs have been developed to accomplish the same thing. The most commonly used in the United States is Lupron or Leuprolide, which is given as a long acting injection once a month.