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.
Prostate Cancer Prevention
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
- 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.
Prostate Cancer Prognosis
The prognosis in prostate cancer depends on the stage of the cancer and the degree of differentiation.
- Differentiation refers to how closely the cancer resembles normal tissue. This is assessed by calculating the Gleason score as mentioned earlier. The less differentiated the cancer, the poorer the prognosis.
- The stage refers to the extent of the cancer -- whether it is localized or has spread beyond the prostate. The greater the degree of cancer spread, the poorer the outlook.
5-year survival rates are very good for men with prostate cancer.
- According to the American Cancer Society, most men with these cancers survive at least 5 years.
- Most prostate cancers are slow growing, as shown by the fact that a majority of men with prostate cancer survive at least 10 years.
- Sometimes, however, prostate cancers grow and spread rapidly. Therefore, early diagnosis is essential for a cure.
If a man is elderly and has other medical conditions, watchful waiting may be the most prudent course.
- Therapy may be more harmful than the cancer.
- This is especially true if a man's life expectancy is less than 10 years.
- Many times, elderly men with prostate cancer actually die of something else, such as heart disease, not the slow-growing prostate cancer.
A man and his family members should discuss this with his urologist.
Support Groups and Counseling
Living with cancer presents many new challenges for a man and for his family and friends.
- A man will probably have many worries about how the cancer will affect him and his ability to live a normal life, that is, to care for his family and home, to hold his job, and to continue the friendships and activities he enjoys.
- Many people feel anxious and depressed. Some people feel angry and resentful; others feel helpless and defeated.
For most people with cancer, talking about their feelings and concerns helps.
- Friends and family members can be very supportive. They may be hesitant to offer support until they see how the man with cancer is coping. Don't wait for them to bring it up. If one wants to talk about their concerns, let them know.
- Some people don't want to burden their loved ones or prefer talking about their concerns with a more neutral professional. A social worker, counselor, or member of the clergy can be helpful if a man wants to discuss his feelings and concerns about having cancer. A urologist or oncologist should be able to recommend someone.
- Many people with cancer are profoundly helped by talking to other people who have cancer. Sharing one's concerns with others who have been through the same thing can be remarkably reassuring. Support groups of people with cancer may be available through the medical center where one receives treatment. The American Cancer Society also has information about support groups all over the U.S.
Medically reviewed by Jay B. Zatzkin, MD; American Board of Internal Medicine with subspecialty in Medical Oncology
"Prostate cancer: Risk stratification and choice of initial treatment"
"Clinical presentation and diagnosis of prostate cancer"
"Screening for prostate cancer"
Medically Reviewed by a Doctor on 12/16/2014
Pierre-Alain Hueber, MD, PhD
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