What’s new about Prostate Cancer therapies for the newly diagnosed male? Well…not much it seems. Variations of a theme?


success favors one in motion

 When you think about it there are only about two things you can do to treat prostate cancer.

  • You can take the prostate and the cancer within out
  • You can treat the prostate with some form of energy

If you take it out you can do it by hand (open) or use laparoscopic instruments with or without the aid of a robot. (End result about the same-yep that’s right!)

If you treat it with energy you can choose your poison (so to speak) between the FDA approved ones or the Non FDA approved ones:

  • You can treat it with external beam radiation shot into you like an X-Ray (usually 42 treatments over 6-7 weeks)
  • Proton therapy is radiation therapy…so in the decision process the big decision is radiation or not then get specific.
  • You can freeze it (cryosurgery)
  • You can use radioactive seeds alone or in combo with external beam (think of 80 pellets put around in an apple)
  • You can use radio frequency to kill the cancer HIFU
  • You can use electricity (so to speak) IRE-The nanoknife
  • You can shake it up and  fry it in a pan—-just kidding.
  • You can do nothing ….is that a treatment…some would say yes.

So even though there are all these forms of therapy and combinations of therapy (and if you elect not to do surveillance) the most common choices are between removal or radiation.

So is ya fer or against surgery? This is the best place to start you decision-making process…this is how it goes:

  • The first thing to do if you are newly diagnosed is do you want to treat it or watch it?
  • Then if you want to treat it do you want it out or do something else.
  • If it is to have it out then you decide on who and how it is removed.
  • If you don’t want surgery then what form of radiation (i.e. radiation consult – speak to someone who does it every day…not your buddy at church.
  • If you don’t like radiation then you can go to the Bahama’s for HIFU or find a pilot program for the nano knife (ps…there is no knife…it just sounds  good) There is one in Atlanta.
  • Yes yes you can just hormones and yes the PSA will go down and the cancer will be in “remission” but hormones don’t cure anything and usually not used as a “treatment for cure”

So the answer to the question in the title…there ain’t that much new in the treatment of prostate cancer in the newly diagnosed patient. More variations on a theme.

There is however a lot being done in the realm of hormone refractory prostate cancer and there are many new forms of therapy in this regard. The Prostate Cancer Info Link site does a very nice job of discussing all the activity in this area and is linked to the right of this post.

4 Replies to “What’s new about Prostate Cancer therapies for the newly diagnosed male? Well…not much it seems. Variations of a theme?”

  1. Hi again Dr. McHugh
    Again, very few of us really know what medical procedures really cost, no matter who pays. I believe it would be quite illuminating for you to publish a simple list of what you know to be the current actual total cost involved for the treatments you’ve described above. We’ve had many discussions on this blog about the government cutting costs and possibly killing patients in the process. So, let’s say government/insurance is out, what then would a newly diagnosed prostate cancer patient have to fork over for each treatment modality? Please include what you belive is the actual cost for robotic and non-robotic surgery, including all hospital costs, as well as all the other “energy” treatments you’ve listed. This should put things in a better persepective. Also, if you get a minute, comment on your experience with certain patients thinking that the most expensive treatment must surely be the most effective.
    Thanks,
    Jack

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  2. This puts treatments into a nutshell but doesnt crack the nut for patients and that is not a criticism of clinicians as I truly believe that most of them do their best with the tools they have before them.

    But for the patient it can be a nightmare that they cannot wake up to.

    The clinician and their patient may feel they have achieved a cure whether it be by RT or surgery they are the lucky ones although for the patient the nightmare they woke up to is one they may in some instances have to revisit.

    Which leads on to you may in most instances cure the cancer but can you cure the patient?

    The unlucky ones are those men whose prostate cancer is either so aggressive it could never be cured or was diagnosed too late for anything other than palliative care to be effective.

    For these not insignificant number of men quality of life should be the Health services prioirty and certainly Abiraterone and Provenge go some way to providing this for men and their families who have at this stage come to terms with the disease.

    Filling the gap between diagnosis and treatment (non treatment) options is a massive one to fill and it is one that I firmly believe (in the UK) that the volunteer support groups could have a major role to play.
    ‘Man to Man’ for those men who have been diagnosed with prostate problems
    ‘Side by Side’ for those who love and support their men.

    My view for what its worth with regards to circumcision, lemon juice, green tea,soya products, pomegranate juice etc etc etc ………… is choose your parents carefully!!!

    Like

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