Cancer Fighters Thrive is a quarterly print and online magazine bringing readers practical, innovative and inspirational information about cancer treatment and survivorship.
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CANCER TYPE Q&A; • There is insuffcient evidence to recommend for or against screening for men ages 40 to 55; patients should discuss screening with their doctor. • Though some healthy men over age 70 may beneft from screening, routine screening is not recommended for men 70 and older nor for men with fewer than 10 to 15 years' life expectancy. Ultimately, it is important that men understand the pros and cons of screening as well as potential treatment, and there should be an open discussion between the patient and his doctor to ensure that each man makes the choice that is right for his unique situation. WHAT ARE THE TREATMENT OPTIONS FOR PROSTATE CANCER? There are many treatment options for patients with prostate cancer, and no one option is best for all patients. Treatment decisions are based on many factors, including the stage and the grade of the cancer, the patient's age and overall health status, the patient's expectations and the risks of treatment. Watchful waiting, or "active surveillance," is a reasonable option for many men with clinically localized, low-stage, low-grade disease. With active surveillance the patient is simply monitored with regular PSA tests and digital rectal exams and intermittent biopsies to monitor the cancer for any growth. This approach allows the patient to avoid potential side effects of treatment that may compromise his quality of life, often with very little risk of the cancer's progressing. Recently available DNA tests enable physicians to test the biopsy tissue and better delineate the aggressiveness of the cancer, allowing them to better determine who may be a 32 cancer fighters thrive | winter 2013 good candidate for surveillance. Potential curative treatments include radical prostatectomy (surgical removal of the prostate), brachytherapy (implantation of radioactive seeds in the prostate) and external-beam radiotherapy (direct targeting of a radiation beam to the prostate gland). Other treatments for high-grade and more-advanced disease include high-dose radiation treatments, combination therapies and androgen deprivation therapy (blocking testoster- urinary symptoms, such as burning, frequency, urgency and hematuria (blood in urine) as well as rectal irritation or bleeding. Like surgery, radiation can also affect erections because the nerve fbers responsible for erections are directly adjacent to the prostate and are exposed to the radiation. Advances in radiation delivery, such as Calypso technology, can help limit the exposure to radiation of surrounding organs and tissue. one production to inhibit the prostate cancer growth). WHAT QUESTIONS SHOULD MEN WITH NEWLY DIAGNOSED PROSTATE CANCER ASK THEIR DOCTOR? Here are a few to get started: • What is the grade and the stage of the cancer? • Is the cancer contained or spreading? • Do I need any further testing? • What are my treatment options? • Am I candidate for watchful waiting/ active surveillance? • Am I a candidate for radical prostatectomy, brachytherapy or externalbeam radiation therapy? • What are my individual risks for surgery versus radiation therapy based on my health, the cancer and my pretreatment urinary and erectile function? • What is the likelihood of successfully eradicating the cancer with each treatment? • What are my treatment options if the cancer recurs? WILL PROSTATE CANCER TREATMENT CAUSE INCONTINENCE OR IMPOTENCE? All treatments for prostate cancer can have side effects, which the surgeon or radiation therapist tries to limit. With radical prostatectomy (surgical removal), the surgeon attempts to preserve as much of the normal anatomy during prostate removal as possible, and patients are advised to perform Kegel exercises to strengthen their pelvic foor muscles to improve the chances of urine control's returning to normal. Over time most patients regain their urine control. For patients who are candidates, a "nervesparing" prostatectomy can be performed, where the delicate nerve and blood bundles adjacent to the prostate, which are responsible for erections, are preserved. With this technique many, but not all, can regain their potency postoperatively. Robotic laparoscopic techniques may aid the urologic surgeon in these attempts to limit side effects. Patients who undergo radiation treatment do not typically develop urinary incontinence, but they can still develop cfthrive.com