Prostate cancer is the most commonly diagnosed cancer in the U.S. Despite its often indolent nature, approximately 30,000 men die of prostate cancer in the U.S. every year, making it the second leading cause of cancer related death.
Since prostate cancer usually does not manifest itself with any noticeable symptoms, the vast majority of cases are detected via screening, which consists of either prostate specific antigen (PSA) or digital rectal examination. PSA is a protein produced by both cancerous and noncancerous (benign) prostate tissue. PSA can be measured by a routine blood test. The upside of screening is that it can help identify prostate cancer at an early stage when treatment is most effective. The downside is that PSA screening can cause unnecessary concern when it is elevated for reasons other than cancer (benign prostate enlargement, prostate infection, etc.). PSA screening often leads to invasive, stressful work-up, which may not be necessary.
The debate regarding screening has heated up recently following two recent publications in the New England Journal of Medicine that indicated that relatively few men have an improved survival from PSA screening, especially men over the age of 75. That has led to doubts as to whether PSA screening should be used at all.
In patients who are diagnosed with prostate cancer, the challenge is then to determine the best course of treatment. Options include watchful waiting vs. radical prostatectomy vs. external beam radiotherapy vs. prostate implant. Decisions regarding therapy depend on the patient’s age, general medical status, PSA, Gleason biopsy score (pathology), volume of disease, and clinical stage of disease.
Although surgery is often recommended by surgeons who perform prostate biopsies (urologists), recent data from a randomized trial comparing surgery (radical prostatectomy or RP) vs. observation demonstrated no overall survival benefit with surgery. In addition, RP is a major surgery, which often leads to urinary incontinence (leaking) and impotence. Robotic prostate surgery has gained recently popularity; however, to date, no studies have shown that it produces superior cure rates to traditional surgery or radiotherapy. While robotic surgery often leads to shorter hospital stays and quicker recovery, some studies have shown it comes at the cost of increased positive margins and the need for additional therapies.
Recent advances in radiotherapy using special delivery methods such as intensity modulated radiotherapy (IMRT) in combination with special daily imaging, seed implantation, or high-dose rate brachytherapy (HDR) have greatly enhanced the delivery of radiotherapy. These techniques have produced cure rates, which are equivalent to, and in many cases, superior to surgery. And just as important, patients do not have to undergo an invasive procedure to achieve excellent cure rates.
If you have been diagnosed with prostate cancer, I strongly recommend you seek a second opinion by a board certified radiation oncologist who specializes in prostate cancer. At Holy Cross Hospital, we offer the latest techniques in radiotherapy in a caring and compassionate setting.
Lav Goyal, M.D., is a member of the Holy Cross Medical Group and practices at the Bienes Cancer Center at Holy Cross Hospital, Fort Lauderdale. Board certified through the America