What do you think is the most aggressvie treatment for prostate cancer? Why is it important in your “decision?”

life is what happens while you're making other plans...j lennon


I have had an ongoing dialogue with a radiation therapist friend  of mine about ” what is the most aggressive therapy for prostate cancer?” What would you say? To me the most aggressive thing would be to  remove the prostate. In the diagram above, from “The Decision”, shows that if the prostate cancer is only in the gland and you remove the gland then you have removed all the cancer. If you do radiation of any type or cryosurgery, or  nanoknife, or hifu or whatever, there is the chance that whatever “energy” used it might not kill all the cancer. So to me, removal is the most aggressive thing to do. Am I missing something here?

“John, you are shooting an  arrow and the  moving the target to suit your preconceived outcome?” I have yet to understand that argument. I mean  it’s a great little saying, I just don’t think it applies to this.

Now to the article below….seems that they think that surgery  is the most aggressive form of therapy and that it works better than other modalities for aggressive prostate cancer. I make this point in the book. You need to know your cancer and then decide what you  feel is the  most aggressive form of therapy and if it applies to your disease.

Why is this important? Because if you feel  you  have an unfavorable cancer, i.e. high volume and high Gleason’s score, then you need to have in  your mind which treatment is the most aggressive. My radiotherapist friend actually  told me that combination  radiation was the most  aggressive. I don’t buy it.

What his point is that in the bad parameter cancers, the disease is most probably into the capsule of the prostate and that all the pain and suffering of surgery may not be of any benefit, i.e. the patient will  need post op radiation anyway. The  report below however finds that patients do better with  surgery first even if  further treatments become necessary.( The PSA rises after the prostate is removed.) From a purely common sense thinking, at least surgery will assure that all the cancer in the gland will be gone, albiet at the price of surgery and its attendant potential  complications. That is another “decision” point and one we  have to  make.

So….put that in your quiver or  pipe to shoot or  smoke  and use it to help formulate what is best for you. Not this article alone, or  my thoughts  alone,but what do you think.   You must decide for you what you feel is the most aggressive form of therapy and then decide if that is what you need for your cancer. If you have a very favorable cancer then you can go with active surveillance or one of the ” energy treatments.”  See my Decision Worksheet and the points that follow for assistance and understanding here.

One size does not fit all. Balancing cure with risks. Arrows in your quiver. Don’t be a one-dimensional prostate cancer patient. Don’t kill a fly with a shot gun…and bla bla bla blah……

Surgery For Aggressive Prostate Cancer Gives 92% 10-year Survival Rate

28 Sep 2010

Patients with the most aggressive form of prostate cancer who have surgery – radical prostatectomy – were found to have a 10-year cancer-specific survival rate of 92%, which is high, and a 77% overall survival rate, according to researchers from the Fox Chase Cancer Center and the Mayo Clinic, USA. This compares to an 88% 10-year cancer specific survival rate and 52% overall survival rate for those who underwent radiotherapy without surgery. The findings were presented at the American Urological Association’s 84th Annual Meeting, Chicago.

Stephen Boorjian, M.D., a urologist at the Mayo Clinic, said:

It’s long been believed that patients with aggressive prostate cancer are not candidates for surgery. We found that surgery does provide excellent long-term cancer control for this type of prostate cancer. In addition, by allowing the targeted use of secondary therapies such as androgen deprivation, surgery offers the opportunity to avoid or at least delay the potentially adverse health consequences of these treatments.

Their study included 1,847 individuals with aggressive prostate cancer. Between 1988 and 2004 1,238 of them underwent a surgical procedure to have their prostate taken out (radical prostatectomy) at the Mayo Clinic, while 609 received radiotherapy at the Fox Chase Cancer Center. 344 of the patients who received radiotherapy were also given androgen deprivation therapy.

The investigators worked out their overall and cancer-specific survival rates:

Patients who underwent surgery had a 92% cancer-specific survival rate, as did those who received radiotherapy plus androgen deprivation therapy (hormone therapy)

77% of those who had surgery had a 77% overall survival rate

Those who received radiotherapy plus hormone therapy had an overall survival rate of 67%

Patients who had just received radiation therapy (radiotherapy) had an overall survival rate of just 52%

Dr. Boorjian said:

Patients with radiation and hormone therapy were 50 percent more likely to die than patients who had surgery. This was true even after controlling for patient age, comorbidities and features of the tumors. These results suggest that use of hormone therapy in patients who received radiation therapy may have had adverse health consequences.

We want to stress that surgery provides excellent long-term control for high-risk prostate cancer patients. Limiting the need for hormones may avoid adverse health consequences. Further studies evaluating the differing impacts of treatments on quality of life and non-cancer mortality are necessary before we can determine the best approach for patients with aggressive prostate cancer.

What is prostate cancer?

Prostate cancer only affects men. Cancer begins to develop in the prostate – a gland in a man’s reproductive system. The word “prostate” comes from Medieval Latin prostate and Medieval French prostate. The ancient Greek word prostates means “one standing in front”, from proistanai meaning “set before”. The prostate is so called because of where it is – at the base of the bladder.

The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. An exocrine gland is one whose secretions end up outside the body e.g. prostate gland and sweat glands. It is approximately the size of a walnut.

The urethra – a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body – goes through the prostate.

There are thousands of very small glands in the prostate – they all produce a fluid that forms part of the semen. This fluid also protects and nourishes the sperm. When a male has an orgasm the seminal-vesicles secrete a milky liquid in which the semen travels. The liquid is produced in the prostate gland, while the sperm is kept and produced in the testicles. When a male climaxes (has an orgasm) contractions force the prostate to secrete this fluid into the urethra and leave the body through the penis.

The epithelial cells in the prostate gland produce a protein called PSA (prostate-specific antigen). The PSA helps keep the semen in its liquid state. Some of the PSA escapes into the bloodstream. We can measure a man’s PSA levels by checking his blood. If a man’s levels of PSA are high, it might be an indication of either prostate cancer or some kind of prostate condition.

It is a myth to think that a high blood-PSA level is harmful to you – it is not. High blood PSA levels are however an indication that something may be wrong in the prostate.

Male hormones affect the growth of the prostate, and also how much PSA the prostate produces. Medications aimed at altering male hormone levels may affect PSA blood levels. If male hormones are low during a male’s growth and during his adulthood, his prostate gland will not grow to full size.

In some older men the prostate may continue to grow, especially the part that is around the urethra. This can make it more difficult for the man to pass urine as the growing prostate gland may be causing the urethra to collapse. When the prostate gland becomes too big in this way, the condition is called Benign Prostatic Hyperplasia (BPH). BPH is not cancer, but must be treated.

In the vast majority of cases, the prostate cancer starts in the gland cells – this is called adenocarcinoma.

In the majority of cases, prostate cancer is a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer – it is only when an autopsy is done that doctors know it was there. Several studies have indicated that perhaps about 80% of all men in their eighties had prostate cancer when they died, but nobody knew, not even the doctor.

Prostate cancer can, however, be aggressive and progress much more rapidly.

Click here to read about prostate cancer in more detail.

Source: Mayo Clinic

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today


Article URL: http://www.medicalnewstoday.com/articles/202732.php

Main News Category: Prostate / Prostate Cancer

Also Appears In: Cancer / Oncology, Urology / Nephrology,


2 Replies to “What do you think is the most aggressvie treatment for prostate cancer? Why is it important in your “decision?””

  1. What better way to show the art of moving the target after the arrow is shot than the Mayo study (presented, I assume not published?) which says “77% of those who had surgery had a 77% overall survival rate”?? Is that a misquote or just Urology-talk?
    There isn’t a word of how the patients were selected for treatment. It just looks like a retrospective review of single institution treatments comparing the Mayo patients who had surgery and Fox Chase patients who had radiation. (Only in Urologic surgical oncology does this type of study meet reasonable scientific standards!) Is there a comment as to the selection criteria? No. “The patients were controlled for patient age, comorbidities and features of the cancer”. Give me a break!! These were different institutions using different selection criteria for different treatment modalities by different oncologists! The author even includes the statement, “These results suggest that use of hormone therapy in patients who received radiation therapy may have had adverse health consequences”. That may be true but Duh….maybe there was a reason the Urologists at Fox Chase sent them to the Radiation Oncologists in the first place. Perhaps many had adverse health issues precluding surgery to begin with! Comparable? I think not.
    What is the median followup? Why the end point of survival and not PSA relapse? Surely the urologists are aware of the problems comparing survival rates in the evaluation of nonrandomized, local treatment modalities for prostate cancer. Probably not.
    Most aggressive treatment for high risk prostate cancer? In the absence of a reasonable prospective study concluding otherwise, in my opinion, in no particular order, 1)the combination of surgery and post-op radiation therapy for those with high risk for relapse features found at surgery (most of them will need the XRTx) and 2)neoadjuvant hormone therapy followed by a combination of external beam treatment and an implant. I usually will suggest #2 unless the androgen ablation is precluded by the comorbities, in which case radical prostatectomy may also be unreasonable.
    I’m not sure why the question of “what is the most aggresive treatment” is being asked. My question would be, based on the available literature, what is the most reasonable treatment for high risk prostate cancer to assure no future manifestations of the cancer, considering the risks of treatment side effects and toxicities . I usually, but not always, answer that with number 2) above.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: