Cancer Treatment

PROSTATE CANCER
By TOM SOTER
from ONE SOURCE, MAY 1995

Cancer is scary. And for men, prostate cancer – which kills some 24,000 yearly – can be the scariest of all. But finding it sooner rather than later can mean the difference between living and dying.

Robert A. knows. Diagnosed with prostate cancer at 53, the financial loan consultant is now cured after having his prostate removed. “I had to make a decision,” he says. “I felt radiation was like trying to shoot a duck with a BB gun. You might hit it or you might not. I don’t like mights. When you’re dealing with cancer, I wanted the biggest baddest weapon I could find. Surgery may be the atomic bomb approach, but that made sense to me.”

Because it was detected early, Robert’s cancer was stopped. But others are not as lucky. The American Cancer Society estimates that 244,000 people will be diagnosed with prostate cancer in 1995 and that 40,400 will ultimately die from it.

The key to a cure is early detection. “The biggest problem is that men don’t go for check-ups,” says Dr. Ian Gale, a urologist and director of the Prostate Center at the West Hills Regional Medical Center in West Hills, California. “It’s not like breast cancer and women, where it’s an accepted practice to visit the doctor regularly.”

One problem is there are few ways to discover the disease yourself. An enlarged prostate and its symptoms – obstruction in the outflow of urine, delay in getting a stream started, dribbling – may indicate prostate cancer but only a doctor-administered test can tell for sure. That means men over 45 should have an annual digital rectal exam and a PSA (prostate-specific antigen) blood test. If the PSA count is even slightly elevated, an ultrasound-guided biopsy is the next step.

If you have prostate cancer, the treatments include:

Surgery. Dr. George Miquel Jr., a urologist at Memorial Hospital in Jacksonville, Florida, says surgery has “the edge now” over radiation as the primary treatment. With a radical prosectemy, the entire prostate is removed in a day-long procedure. If the cancer has not already spread, Gale says there is a 90 percent probability of cure. The side effects include blood loss, impotence, and leaking urine, but Gale reports that modern treatments can reduce the incidence of all three.

“The prostate is like the appendix,” Gale notes. “It makes seminal fluid for the sperm. Once you are no longer interested in making babies, it has no value.You can still have intercourse after it’s removed.”

Radiation. There are two ways radiation is used: through an external beam or with radioactive “seed implants.” The implants are placed in the prostate using hollow needles and ultrasound guidance, but the method is controversial and has had limited success. Gale says complications in any type of radiation involve bowel and bladder irritability, incontinence, and impotence.

W.M., a 77-year-old from Georgia, successfully employed external radiation therapy. After discovering the cancer through a PSA test, he had an ultrasound biopsy (which he calls “a wicked, painful thing”) Additional biopsies confirmed it, so he went through a series of 32 10-minute radiation treatments. His PSA dropped remarkably, and he was declared cured. (One unusual side effect: W.M.’s sex drive increased.”My doctor didn’t know why,” he recalls, “but he told me to relax and enjoy it.”)

Cures are not always certain, however, which is why check-ups follow at six-month intervals. “With radiation treatment, recurrence varies,” notes Dr. Rashmi Chobe, a radiation oncologist at the Florida Cancer Center in Jacksonville. “Late detection means the chance to cure decreases."

Other treatments. In the past, treatments have included removing the testicles and ingesting female hormones, but the latter is rarely done now because patients have developed heart problems or strokes. There is also “watchful waiting,” usually for those 75 or older, which means monitoring the spread of the slow-moving disease.

There are also newer, experimental drugs being tested: Miquel cites lubron [lupron], which prevents testicles from producing testosterone, a “fuel” for the cancer. Biomune Systems in Salt Lake City, Utah, has also developed a drug that may retard the growth of prostate cancer tumors. Research showed an 11 percent decrease in the growth rate of cancer tumors treated with the drug.

But, observes Gale, “the best way to reduce your risk is early detection before it has spread.” Agrees W.A.: “I encourage any male over 40 to have the PSA test and a regular physical check-up of the prostate. Do not stand back. I read a lot of articles that say maybe you’ll outlive the problem. But I could never live with myself knowing a malignancy existed inside me.”