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Prostate Cancer (cont.)

Prostate Cancer Follow-up

Follow-up care is especially important for patients who opted for a more conservative approach (such as watchful waiting) to treat prostate cancer. It is imperative that a man see his urologist for digital rectal exams, PSA level tests, and other tests as recommended to follow the progression of cancer growth.

For men who have undergone radical prostatectomy, radiation therapy, or both, follow-up care is important to prevent cancer recurrence.

  • PSA has been shown to be useful in detecting recurrences. PSA levels should be less than 0.2 ng/mL after radical prostatectomy.
  • PSA levels should be checked every 3 months for 1 year, every 6 months for the second year, and annually after that.
  • A man should have a physical examination, including digital rectal exam, every 3 months for 1 year, then every 6 months for a year, then yearly after that.
  • In certain cases after radical prostatectomy, additional treatment may be required based on the final pathology report of the removed prostate or if the PSA starts increasing after surgery.
  • This may be in the form of additional radiation treatment to the area where the prostate once was and/or hormonal treatment with LHRH agonists or antiandrogens as mentioned earlier.

How to Prevent Prostate Cancer

The high lifetime risks of prostate cancer development, the morbidities associated with treatment of established prostate cancer, and the inability to eradicate life-threatening metastatic prostate cancer offer compelling reasons for prostate cancer prevention.

However, because the cause of prostate cancer is uncertain, preventing prostate cancer may not be possible. Certain risk factors, such as age, race, sex, and family history, cannot be changed. Nevertheless, because diet and other lifestyle factors have been implicated as a potential cause, living a healthy lifestyle may afford some protection.

  • Proper nutrition, such as limiting intake of foods high in animal fats and increasing the amount of fruits, vegetables, and grains, may help reduce the risk of prostate cancer.
  • The following supplements should NOT be used to prevent prostate cancer:
    • Vitamin E
    • Selenium
    • Vitamin C

5-alpha reductase Inhibitors (5-ARI):

  • Using 5-ARIs for prostate cancer is controversial.
  • Initial studies have shown that finasteride decreased the risk of developing prostate cancer by 25% (Prostate Cancer Prevention Trial). However, initial reports indicated that, while fewer cases of low and intermediate grade prostate cancer did develop resulting in about a 25% lower risk of developing prostate cancer overall, high-grade prostate cancer was more likely to occur in men treated with finasteride. Even though this increased risk with finasteride may be due to a selection bias, there is no proof that finasteride would not increase the true incidence of high-grade cancer.
  • In the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial, dutasteride decreased the risk of developing Gleason score 5 to 6 cancer but not Gleason 7 to 10 cancer.
  • In both trials 5-ARIs increased the risk of erectile dysfunction and loss of libido.
  • Although it is possible that 5-ARIs reduced the risk of being diagnosed with prostate cancer, it is unknown if this will translate into reduced mortality.
  • 5-ARIs are not FDA approved for the prevention of prostate cancer.
Medically Reviewed by a Doctor on 3/31/2015

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