Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Several treatments are available for prostate cancer.
The choice of treatment depends on age, general
medical condition, and the extent of the tumor spread.
Your treatment plan should be individualized for you,
depending on your feelings about the different treatments and their potential
side effects.
You should discuss your treatment plan with your medical team, which will probably consist of a urologist and cancer specialists (oncologists).
One treatment option is known as watchful waiting. This involves monitoring your cancer to see if it gets worse and how quickly.
Often prostate cancers grow very slowly, and many men
do well without treatment for some time.
For older men with other serious medical problems, the
risks involved with treatment such as surgery may outweigh the potential
benefits.
Watchful waiting is a conservative regimen that includes regular visits to your urologist for digital rectal exams, PSA measurements, and, if necessary, imaging tests and/or repeated prostate biopsies to assess if the cancer is becoming more aggressive over time.
One benefit to watchful waiting is that you do not
experience the side effects of treatment. On the other hand, your symptoms (if
any)
will continue. In some cases, symptoms can be at least partly relieved with
medication.
If your cancer starts to grow, your urologist may
recommend treatment.
Watchful waiting is most often used for men who have very early-stage cancers and for men who are not candidates for surgery and other aggressive therapies.
Radical prostatectomy: This is a major operation to remove the entire prostate gland. For more information, see Surgery.
Radiation therapy: Two types of radiation therapy are used in prostate cancer: external beam radiation therapy and brachytherapy. Both are used to treat prostate cancer that has not spread outside the prostate.
External-beam radiation therapy involves targeting a
beam of high-energy radiation directly at the cancer. If the cancer is limited
to the prostate, without capsular, lymph node, or any distant involvement, the
survival rates are nearly similar to those achieved with radical prostatectomy.
Radiation therapy has also been used to treat cancer
in which there has been localized spread of the cancer outside of the
prostate.
Brachytherapy (internal or implanted radiation) is a variation of radiation therapy in which a small radioactive pellet is implanted into the prostate. An imaging technique, such as transurethral ultrasound (TRUS), CT,
or MRI, is used to accurately place the radioactive pellets. This provides
radiation to a smaller area than external-beam radiation and minimizes
exposure of surrounding normal tissue. The pellets provide radioactivity for
weeks to months and can simply be left in place once exhausted.
Side effects of external beam radiation include skin burning or irritation and hair loss at the area where the radiation beam goes through the skin. Both can cause severe fatigue, diarrhea, and
discomfort on urination. These effects are almost always temporary.
Both treatments can cause impotence (inability to get an erection) and/or urinary incontinence (inability to hold your urine). This occurs because the radiation damages the nerve
and the muscles that control these functions. These effects may be permanent, but they are less likely to be permanent with internal radiation.
Hormonal therapy: This therapy is likely to be used in cases in which the cancer has spread to distant regions. The goal of hormonal therapy is to lower levels of testosterone or to stop testosterone from working. Prostate cancer is stimulated by testosterone and other male hormones (androgens). These effects on testosterone can be achieved with surgery or with drug treatment. Often, the initial response is good, but cancer may progress over time.
The testes produce much of the testosterone that
stimulates cancer growth. Surgical removal of both testicles (castration, or
orchiectomy) is the best way to stop hormonal stimulation of the tumor.
Men usually prefer medical castration to surgical castration. A luteinizing hormone-releasing hormone (LHRH) agonist, such as leuprolide (Lupron,
Viadur, Eligard), goserelin (Zoladex), or buserelin (Suprefact), stops the
production of testosterone.
Agents that stop testosterone from working, such as flutamide (Eulexin) or bicalutamide
(Casodex), are called anti-androgens. They are typically used after
orchiectomy or with an LHRH agonist to more completely suppress the effects of
testosterone on the cancer.
Drugs that stop the adrenal glands from making
androgens are sometimes used.
Estrogen, in the form of diethylstilbestrol, can also
be used to suppress testosterone. Because of its extensive side effects,
estrogen is not used very often.
Side effects of these medications vary. Orchiectomy and LHRH agonists may cause impotence, hot flashes, and loss of sexual desire. Antiandrogens may cause nausea, vomiting, diarrhea, and breast enlargement or tenderness. Any of these therapies can weaken bones.
Chemotherapy: Chemotherapy is the last treatment method to be used against prostate cancer.
Newer chemotherapy medicines, such as
docetaxel (Taxotere), have shown some promise in prolonging the survival of some patients with extensive prostate cancer. They may also decrease the pain related to widespread cancer. However, this comes at the cost of significant side effects that may impact quality of life.
