Prostate cancer Living Against All Odds. How to Treat Prostate Cancer. By myprostateok Posted on 12.02.2017 38 min read 0 0 1,644 Share on Facebook Share on Twitter Share on Google+ Share on Reddit Share on Pinterest Share on Linkedin Share on Tumblr Prostate cancer is a serious issue. There is no doubt about it. This disease affects many men all over the world and account for over 15% of all cancer cases. This makes it the second most common type of cancer is USA (lagging behind only lung cancer). Prostate cancer is a disease that every single male on this planet should be aware of and try to prevent by all means necessary. However, even the most meticulously constructed healthy lifestyle and proper medication plans may not prevent prostate cancer that has a strong genetic etiology. If you were diagnosed with cancer, you need to remember that this is not the end. When diagnosed early, prostate cancer can be cured and completely banished away. Even when the tumor develops and starts spreading, the chances of recovering are quite high. The only truly devastating news for any person would be that the metastasis began. My first and foremost advice to all men who are concerned with prostate cancer or have been recently diagnosed – do not give up! This is not the end, there are still great opportunities to recover, and you will easily make it through the hardest period of your life and be victorious in the end. Keep hoping and keep fighting. The mental state is detrimental, but without a proper treatment plan even the most stoic men will fall. Let’s talk about the most common and most effective means of prostate cancer treatment. Work with a Team of Professionals. You will most likely be offered to work with a special multidisciplinary team of medical specialists who will carefully tailor the most efficient treatment course. This team usually consists of physicians, nurses, pharmacists, dietarians, and many other professionals. Their main goal is to work together to come up with a perfectly balanced treatment strategy that involves: Proper nutrition and selective dieting; Psychological support and assistance in socialization; Symptomatic treatment; Medication planning; Physiological procedures; Nursing There are various possible strategies that may or may not involve aggressive or passive types of treatment depending on the severity of cancer. Your medical care team will most likely try to cooperate and develop a strategy that will consist of several distinct treatment courses that mesh well together. For example, your physicians may suggest various physiological procedures that will complement drugs that you take. Discussing each aspect of treatment with your team is imperative. I have a big advice to all men – don’t feel awkward, don’t be afraid. It is drastically important to discuss some matters with your doctors openly and without any doubts. Knowing survival rates, recurrence probabilities, quality of life, and effectiveness of specific strategies will help you to pick the right course of actions. I know men who were reluctant to talk about frightening matters openly and with all available specialists. They lost precious time and made wrong decisions. At the same time, the skill level of the team that will be responsible for your treatment is crucial. Incompetent specialists will not level up your chances of recovery and survival. Choose your team wisely, search for the best specialists that you can afford. Treating prostate cancer is expensive. Passive treatment. Non-aggressive strategies. Sometimes, the tumor develops slowly and does not cause troubles. While the malicious nature of the tumor may frighten some men, the real negative effect of cancer is minimal at this point. Active aggressive methods of treatment may actually do more harm than good and severely reduce the quality of life while yielding from little to no results. In such cases it is wise to wait and observe the tumor regularly inspecting it and making sure that the condition does not worsen. There are two major types of treatment strategies. Type 1. Active Surveillance. There is a fairly big chance that the quality of life will be reduced after a treatment. Even the most successful and precise methods may leave you with a nearly untreatable erectile dysfunction and urine incontinence. Both conditions negatively affect how you live. Due to the severity of the consequences, many doctors suggest to postpone the treatment and start all active invasive procedures as late as possible. Active surveillance means that immediate treatment is actually undesired and monitoring the condition of the prostate cancer tumor is much more preferable at the moment. This type of passive treatment is strongly recommended to men whose life expectancy is long. Such men will benefit from less invasive non-aggressive treatment courses that have a curative nature. Active surveillance includes regular checks with your doctor and scheduled testing such as: A Prostate-Specific Antigen should be checked at least 2 times per year, 4 times is strongly recommended. A Digital Rectal Examination should be done at least once a year. Your doctor should also schedule regular biopsies with the repletion of the biopsy within 1 year and then consecutive biopsies each 2-3 years. When the symptoms worsen or cancer starts causing major problems with urination, the treatment should be started immediately. The necessity of the treatment should be decided by the patient. This means that it is you who must say the decisive word. Type 2. Watchful Waiting. For men with shorter life expectancy and having more concerning health conditions watchful waiting is a much better course of treatment. All types of surveillance are usually voided. If cancer does not cause problems, the treatment is also not applied. Specific treatment methods may include ADT-courses and other parts of systematic treatment. The biggest difference here is that you don’t have to go through checks, inspections, and testing all the time. You and everyone around know that you have cancer, but you basically can’t do much about it due to having even worse things to worry about. Localization of the Tumor. Targeted Treatment. Local treatment is the best way to address tumors that have not spread throughout the body. For early-stage prostate cancer this is the best course of actions. Targeted radiation and surgery will most likely be effective. The problem with these methods is that they are essentially useless against cancer that spread to nearby bone tissues or metastasis. Local therapy must be truly well-targeted and has to be applied after a determinative diagnosis has been done. Surgical Invasion. Three major types. While in many cases surgical treatment is the least desirable course of action, it is also the most effective when done correctly and with a good timing. A surgeon can completely remove corrupted tissues. The big problem is that impotence is nearly guaranteed after a surgery. Removing a part of the gland without harming nerves nearby is nearly impossible. While some merciful techniques are practiced, the vast majority of surgeries end up “rewarding” you with a severe erectile dysfunction. This condition can be treated with PDE5 inhibitors like sildenafil or tadalafil. Prostatectomy (open). A radical prostatectomy is a widely invasive technique that has a bunch of possible complications including urine incontinence and impotence. As mentioned above, sparing surgeries are possible. However, removing seminal vesicles and the whole gland usually leads to inability to have orgasm and/or achieve erection. Prostatectomy (robotic/laparoscopic). This type of surgery is considered to be way less invasive and has less possible complications, but impotence and urine incontinence are still common side effects. Conventional method is cheaper and increases the level of pain, bleeding, and recovery time. If you can afford laparoscopic method, you should go for it. The differences in success rate and recurrence are negligible. Cryosurgery is the latest technological advancement in prostate cancer treatment. A small metal device is inserted in the gland and cancer cells are being frozen. This is not a dangerous type of surgery, yet the effects have not been studied nor the probability of consequential complications like impotence and urine incontinence. Targeted Radiation Treatment. Energetic rays of radiation can easily destroy cancerous cells. An effective treatment strategy usually consists of several systematic procedures. The cycle can be repeated later. There are various types of radiation treatment methods: External radiation. It is common to use CRT results in order to analyze and evaluate the severity of the cancer case. However, the results of CRT can be used to pinpoint the most impacted areas of the body where cancer develops. The tumors and even separate small groups of corrupted cells can be mapped and targeted via beam therapy. The most frequent type of this therapy is IMRT or Intensity-Modulated RT. A computer program calculates the most effective dosage of radiation and optimal angles of rays to effectively treat the tumor. The calculation is based on the 3D map of the prostate gland acquired during the CRT. Another method of external treatment is proton therapy. Internal radiation. Brachytherapy is the most common type of internal radiation treatment. Small radioactive “seeds” are inserted directly in the prostate surgically. The intensity is regulated by the time of residence. For example, high-dosage seeds are used for seeds that are placed for a couple of hours and low-dosage seeds are used for long-time continuous sessions lasting for weeks. This is an effective treatment type and should be used together with other techniques in order to increase the overall chance of success. Radium-223 is the latest advancement in cancer treatment and widely used to reduce the severity of cancer that spread to bones. It is considered to be a very resultative type of treatment. If possible, go for it. Warning! Radiation is definitely not the safest nor merciful type of treatment causing a wide range of side effects like diarrhea, bleeding, problems with urination, impotence, pains. Note that impotence is permanent with PDE5 inhibitors being the only effective mean of treatment. Systemic Treatment Types. There is a wide variety of possible treatment courses that can be used to minimize the effect of prostate cancer. However, the most efficient ones are usually those based on androgens. ADT stands for androgen deprivation therapy and used to inhibit the growth of the tumor inside the prostate gland. This is a type of treatment that does not need surgical invasions nor drastically affects your quality of life. ADT is a common choice for treating recurrent cases and metastatic cancer. The mechanism of the treatment is quite simple. By reducing the production of testosterone in the body, ADT significantly slows down the growth of all tissues and severely inhibits the ability of tumor to grow in size and spread to nearby tissues. The testosterone production center of the body is testicles and surgical castration is usually recommended. ADT is usually a follow-up technique after a surgery and used to treat patients who selected radiation therapy as their main treatment method. Note that systemic treatment is a must for men with a high risk of cancer and should be used in case cancer cells spread to lymph nodes nearby. Various studies suggest that combining ADT with strong chemo is usually a good way to reduce the probability of recurrence. You should know that there are various types of ADT and surgical castration is not the only way. However, the mechanism is the same – the main goal of this treatment is to stop or minimize the production of testosterone in the organism. I want to tell you about the most effective methods of ADT: Bilateral orchiectomy – this is a beautiful name for an operation that we know as castration. Used as an effective way of cancer treatment more than 70 years ago is remains as one of simplest and effective ways of aggressive systemic treatment. LHRH. Luteinizing hormone-releasing hormone is a special compound that blocks the production of testosterone by preventing testicles from receiving commands to start the production of hormones. This drug is injected under the skin and the course may last from 1 month to 1 year depending on the intensity of the course. Note that the initial intake of LHRH often leads to a spike in testosterone production causing side effects in men with cancer that spread to other tissues. LHRH antagonist or Firmagon is another blocker of testosterone production that doesn’t cause the initial spike. Anti-Androgens. There is a whole list of medications that do not stop the production of hormones but rather stop cancer cells from using them. Amongst the most famous drugs from this category: Casodex, Eulexin, Niandron. These are distributed in pills and should be prescribed to men with cancer that actually responds to androgen deprivation treatment. An early stage of prostate cancer is usually a good spot to start anti-androgens. CYP17 Inhibitors are drugs that prevent other body parts from producing testosterone. While the center of hormone production is situated in testicles, other parts of the body can produce testosterone in smaller amounts. Combined strategies. There are techniques that are based on a combination of ADT methods. These are used when the tumor is still responsive to ADT, but one method is insufficient for a desirable effect. Usually surgical castration is used together with other means of lowering the level of testosterone and anti-androgens. Temporary side effects of ADT are usually not as severe as from other types of treatment. All of side effects usually wear off after you stop taking testosterone lowering drugs. These are conditions you may experience while undergoing an ADT treatment: Erectile dysfunction; Low libido; Sweating and flushing; Gynecomastia (breast growth); Depression, stresses; Rapid weight gain; The acceleration of catabolic processes (losing muscle mass); Osteoporosis and other bone related conditions. The problem of any hormonal treatment is that the body may react by developing a metabolic syndrome leading to obesity, increasing blood cholesterol, and blood pressure. This often results into a higher risk of strokes and heart diseases. Quite common consequence of such a metabolic crisis is diabetes. There is no way to stronger stress how important it is to discuss all possible outcomes and effects of any systemic treatment with your doctor. In many cases, castration is not as beneficial as it seems and advantages are easily outweighed by possible problems and complications. It is also extremely important for you to regularly visit your local gym, eat healthily, and include in your ration calcium, vitamin D, and a glucosamine/chondroitin complex. Chemotherapy – your last resort. Chemotherapy is an extremely aggressive type of treatment that targets cancer cells all over the body and severely inhibits their ability to divide. This systemic treatment relies on your own blood vessel system that acts as a mean of transportation for the intravenous cocktail of medications that start “hunting” down cancerous cells all over the body. When the prostate cancer enters its castration-resistant form, there is no better way to systemically treat the disease than chemo. There is a long list of possible drug combinations that can be used to treat prostate cancer. Amongst the most effective are standard cocktails consisting of prednisone and docetaxel. In specific situations, mitoxantrone may be added to the mix in order to control pain levels. However, lately, mitoxantrone has been replaced by a much safer and slightly more effective Jevtana. The list of possible side effects is extremely long and the severity of these conditions as well as the number of them depends on the intensity of the therapy, length of chemotherapy, and types of medications used. Here is a shortened list of possible negative side effects: General fatigues, feeling weakness in muscles; Nausea, vomiting, constipation, diarrhea; Sores in the mouth, throat; Problems with blood including hemophilia, anemia, etc.; The loss of appetite, frequent changes in mood; Erectile dysfunction, low testosterone, low libido; Hair loss, changes in skin condition; Cognitive disorders including changes in memory, thinking, and perception. The vast majority of these side effects have a temporary nature and will go away right after the end of the treatment course. However, there is a possibility that some effects stay for a long time or even become permanent. This is often the case for problems with digestive system, cognitive disorders, and some other conditions. Warning! I recommend you to discuss every single detail of chemotherapy with your doctors. Knowing how well the positives of treatment fair against its downsides is extremely important when choosing the best treatment plan for prostate cancer. Vaccination. Some types of systemic immunotherapies may prove to be efficient. Your body has some means of fighting cancer back and reinforcing your body is also a good strategy when treating prostate cancer. In order to boost your immune system, you will be given drugs like Provenge (Sipuleucel-T). The process is quite slow and highly technological. The procedure requires a complete removal of blood from the patient and major modification of its properties in the lab. This is a complementary treatment method and should not be considered as the main mean of treating the disease. How to Develop a Good Plan? When you are struck by the news that you have cancer, keeping yourself together is the priority number one! This doesn’t mean that you can make it relying on the sheer strength of your wit, but being hopeful and constantly weighing your chances to recover may significantly improve the quality of treatment. Now, determining the best course of action will be your first step towards curing yourself and choosing the most effective set of methods for each stage of prostate cancer is imperative. Depending on the stage of cancer, the treatment strategy should be adjusted. Early Stages. When the tumor is localized in the prostate gland and cancerous cells do not spread to nearby tissues, the Gleason score for it should be less than 6. This is the initial stage of cancer and it takes years to grow to a size where it starts menacing your health. Usually, passively observing the tumor is the best course of actions, but external or internal radiation therapy combined with innovative safe clinical trials may also be helpful. When the Gleason score is higher than 6, more aggressive methods are often recommended. Advanced Prostate Cancer. When the tumor has a larger size and the spreading has nearly started, local treatment methods may not be sufficient. At this point a combination of treatment methods should be considered. A prostatectomy followed by systemic ADT and radiation therapy is a good answer to a large cancer tumor. Metastatic Prostate Cancer. When the tumor starts spreading to other parts of the body, scientists call it metastatic prostate cancer. This is a condition that cannot be cured, but it can be treatable extending one’s life span for much longer. While healing completely is impossible, having a relatively high quality life and even outliving cancer is quite possible! However, it is a terminal stage of cancer and it can’t be helped. While the news about metastasis can be devastating, try to keep calm and think about the best way to fight it off. Sometimes, palliative support is preferred over aggressive treatment that often significantly reduces the quality of life. At the metastasis stage, radical prostatectomy, pelvic lymph removal, and other aggressive methods do not have a chance to cure cancer. Usually, the only effective answer to a metastatic cancer is ADT. Oftentimes, a systemic ADT course is combined with intense chemo. The combination of these methods I being actively studied and recent researches suggest that docetaxel and ADT are a good combination that may significantly slow down the spreading of cancer. ADT-resistant Prostate Cancer. In some cases, prostate cancer simply stops responding to androgen deprivation therapy. This is usually called castration-resistant prostate cancer. Chemotherapy and vaccination may be helpful in such situations, though the results are tentative. Palliative Treatment. When recovery is impossible and treatment causes more harm than good, palliative care is the most optimal course of actions. This type of treatment focuses on inhibiting symptoms rather than actively targeting the root of the problem. The most important pivot of such treatment is making the quality of life of the patient as high as possible. There are various types of treatment techniques that can be used for palliative care. To name several: Transurethral resection of the Prostate or TURF is an operation that helps in preventing bleeding and severe urinary blockages. Zolendronic acid as a preparation that fortifies bone structure. This is a good prevention technique to reduce pain that accompanies the corruption of bone tissues by cancer. Intravenous radiation treatment also helps to reinforce your bones. The Main Takeaway! That was a long read. However, the only thing that I wanted to highlight in this long article is that prostate cancer is not the end and you have a plenty of options. Do not be afraid think about each step. You will make it through! For those who don’t have cancer we have a simple piece of advice: Live a healthier life, eat better and workout regularly! Live a full sexual life (make sure to ejaculate at least 20 times per month)! Implement preemptive therapy methods like prostate massage and alpha-blockers. Let me think what you think about prostate cancer treatment!