Catch prostate cancer early – while localized to the prostate – and survival rates are very high. A 2006 study in the Journal of the American Medical Association found that men who are diagnosed with low-grade prostate cancers have a minimal risk of dying from prostate cancer up to 20 years after diagnosis.
So Many Treatment Choices
Despite the encouraging outcome, determining a course of treatment can be a harrowing experience for many newly-diagnosed patients. Sorting through all the options -- radical and robotic prostectomy, external beam radiation (including intensity-modulation therapy and proton beam therapy), brachytherapy, cryoblation, androgen deprivation therapy, watchful waiting, and high-intensity focused ultrasound therapy -- can be extremely confusing.
Physicians Have Varying Opinions
Making matters worse, doctors often disagree on which treatment is best for early prostate cancer. According to a report by the Agency of Healthcare Research and Quality, published by the U.S. Department of Health & Human Sciences (Feb 5, 2008), the authors looked at 592 published articles on prostate cancer treatment and found the scientific evidence severely lacking regarding which treatment option is more effective and less harmful over the long-term.
What Researchers Uncovered
Culled from the report, here are 8 things that men should be aware of when making a treatment decision.
1. Not enough scientific evidence exists to identify the most effective therapy for all men, especially those whose cancer was discovered by a PSA test. Still, less than 5 percent of patients report dissatisfaction or unhappiness with their treatment decision. In fact, more than 90 percent said they would make the same treatment decision.
2. There are adverse side effects for all treatment options, primarily bowel, urinary and sexual. Yet the severity and frequency of these issues, as well as the cost for treatment, are important factors in the decision process. Often these factors are glossed over until after the treatment and the side effects cannot be reversed.
3. Sexual dysfunction was common following all aggressive treatments. Fifty-eight percent of men undergoing radical prostatectomy, 43 percent undergoing radiation therapy, and 86 percent undergoing androgen deprivation therapy experienced erectile dysfunction. The younger the patient, the less frequent these problems. Some newer treatments like intensity-modulated radiation therapy and proton beam therapy may result in fewer side effects, but the science is still lacking.
4. When a patient confers with medical professionals about a treatment, physicians were more likely to recommend procedures they performed regardless of tumor grades and PSA levels. In other words, urologists are likely to recommend surgeries and radiation oncologists recommend some form of radiation.
5. The more prostate surgeries a physician performs, the better the outcomes. Urinary complications and incontinence were lower for patients whose surgeons performed more than 40 radical prostectomies per year. Even the length of hospital stay was shorter in patients operated on by surgeons who performed more radical prostectomies per year.
6. Annual PSA tests once a man reaches 50 cannot be stressed enough. In years past, digital exams primarily detected the cancer, often in a later and more dangerous stage. Estimates from large ongoing screening trials suggest that the PSA test increases the time of detection by 5-15 years. Therefore, it is likely that men with PSA-detected tumors will have better 20-year disease-specific survival than a cohort who has not had the PSA test.
7. The most common side effect of prostate cancer treatment is urinary leakage. In a radical prostatectomy, leakage results 35 percent of the time and in radiation therapy 12 percent of the time.
8. The research and data is sketchy regarding the effectiveness of some of the newer treatments: laparoscopic (including robot-assisted) radical prostatectomy, androgen deprivation therapy, and high-intensity ultrasound or radiation therapy.
Get Informed About Prostate Cancer Options
"This report is a reminder that patient outcomes may vary according to treatment settings," said AHRQ Director Carolyn M. Clancy, M.D. "But this analysis also underscores a broader message: when it comes to prostate cancer, we have much to learn about which treatments work best, and patients should be informed about the benefits and harms of treatment options."
Other articles on prostate cancer by Steve Vogel
Prostate Cancer: Are You At Risk?
Prostate Cancer: Treatment Options?
