Prostate-cancer patients have options
Lots of factors will drive the decision-making process, says Dr. Blake Johnson, urologist at LDS Hospital and Salt Lake Regional Medical Center. Prostate cancer is "staged" on a formula called a Gleason score, which looks at how aggressive it is and how advanced. The higher the score on a scale of two to 10, the more advanced the disease.
Johnson and Dr. George Middleton, urologist at Cottonwood Hospital, will discuss prostate problems, including prostate cancer, during today's Deseret Morning News/Intermountain Healthcare Hotline. They'll take phoned-in questions from 10 a.m. to noon. All calls are confidential.
"One difficulty is there are some who don't need treatment, but the problem is we don't know how to exclude those individuals. We don't know who really needs treatment and who would be OK to watch and not do anything. In general it's slow-growing and the survival rate for those with a low Gleason score is the same whether they have treatment or not," Johnson says.
"Watchful waiting" is most often selected when the cancer is not aggressive and the patient is elderly or has other significant health problems. Even then, the waiting is an active process, Johnson says, with repeat biopsies and prostate-specific antigen (PSA) measurements to see what it's doing. Significant change may alter the approach.
Because it's typically, although not always, a slow-growing cancer, many patients are apt to die of something else even if nothing's done, Middleton says.
Hormonal therapy is usually reserved for cases that have spread to the bone. "We try to drop the testosterone level in the body, since the cancer tends to be dependent initially on testosterone to grow," Johnson says. "It's not a cure usually, but it can help slow down the process and reduce pain."
Chemotherapy has not proven effective with prostate cancer, although it may be used palliatively to improve quality of life and treat pain, he says.
Radiation is used with the intent to cure the cancer. But other factors drive that decision, as well, Johnson says. "We are hesitant to consider it for two groups: young men or those with a significant amount of urinary symptoms because radiation can make that worse." In patients 75 and older, Middleton says, radiation is "likely to maintain you until you die" of something else.
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