Modern Approach
When it comes to cancer, everyone knows that it is necessary to pay attention to negative symptoms as early as possible so that doctors can diagnose the disease in time and begin active treatment. That is, to prescribe chemotherapy drugs or radiation treatment to a patient with quite serious side-effects which not all patients can tolerate. It is in connection with the complexity and unpredictability of each situation and the features of existing treatment methods that researchers at Johns Hopkins University are convinced that with regard to prostate cancer, one should not rush to prescribe aggressive therapy methods.
According to the observation of many doctors, prostate cancer is found in a large number of patients who have survived to old age and who have died from cardiovascular diseases or any other ailments not related to oncology. As a rule, this is a slowly developing tumor not able to give metastases. It is these tumors that American experts advise their colleagues not to touch.
If in these cases the patients had any symptoms and the doctors found cancer, aggressive treatment would be prescribed that would not allow the patient to live as long as he lived without treatment. In this case, the best tactic for physicians is simply to observe the situation from the outside. So, a patient will be able to live up to 75-85 years if the cardiovascular system allows.
Medical Studies In-Depth Overview
Research results were published in Clinical Oncology. In the course of the study, scientists analyzed statistical data on long-term survival in 1297 patients with a diagnosis of low-aggressive prostate tumor. According to the head of the group of researchers, Professor Carter, the aim of this work was to determine the possibility of patients with this diagnosis to avoid invasive intervention and radiation.
All the men who participated in the study were previously diagnosed with a non-aggressive tumor of the prostate gland and during the course of the disease they were observed by a urologist. As the results of the analysis showed, only two patients out of almost 1.3 thousand people died of cancer, which is 0.15% of the total number of all patients, while one of them died 16 years after the onset of tumor formation. In another three patients, metastases appeared after 15 years of tumor development. Of all the participants in the study, 47 people died, but the cause of death was not an oncological disease. Of the total number of deceased, nine people received an anti-tumor course of treatment. According to scientists, the most common cause of death in such patients was cardiovascular disease.
According to the results of a study by American scientists, even after 10 and 15 years, the survival rate from this cancer was 99.9%. The proportion of surviving patients without metastases was also almost 100% (99.4%). Thus, according to scientists, non-aggressive prostate cancer is better not treated, since the probability of dying from a prostate tumor is 24 times lower than from other diseases.
According to statistics, today for men with this disease, the observation position instead of active treatment methods is chosen by more than 80% of Scandinavian doctors and up to 40% of US oncologists. At the same time, the number of patients with prostate cancer is increasing every year: for example, only this year in the USA this diagnosis was received by 220.8 thousand people.
In most economically developed countries of the world (USA, Canada, Northern Europe, etc.), prostate cancer occupies the first place in the structure of the incidence of male population with malignant neoplasms. The growth rate of this pathology in our country suggests that soon this “epidemic” will reach us.
Unfortunately, statistics show that patients with early (localized) forms of prostate cancer in our country are detected much less than in most civilized countries, and this worsens the prognosis of the disease.
Only widespread propaganda of basic information about this disease, the importance of regular visits to a urologist – oncologist, an ultrasound examination, determination of prostate specific antigen (PSA) indicators can detect prostate cancer in its early forms, and, therefore, completely cure the patient.
How Does Prostate Cancer Develop?
The prostate gland is an unpaired male organ, which is located in pelvis and covers urethra. In a large percentage of men, prostate tissue degenerates and grows with age; this is benign prostatic hyperplasia. This tumor is not life-threatening, but it can squeeze urethra, preventing the outflow of urine and threatening with acute complications associated with it. Against the background of hyperplasia (and often without it), a focus of malignant cells, prostate cancer, can occur.
The diagnosis of prostate cancer has improved significantly due to the widespread adoption of the method for determining prostate specific antigen (PSA). This is a simple laboratory test in which a specific protein is found in blood; it exists only in prostate gland, which is why it is considered specific to this organ. This protein is not cancerous, so it is found in all men. Its content in blood as a whole is proportional to the volume of the glandular tissue of prostate, therefore, even with a benign increase (hyperplasia), the level of PSA is also increased. So, a high PSA level does not mean the presence of cancer, and some drugs and herbs can reduce this figure by half. Therefore, the question of interpreting the results of PSA is not simple at all, and this analysis is used for the initial selection (screening) of suspected prostate diseases.
The final diagnosis of prostate cancer is made on the basis of microscopic examination of pieces of gland taken from different parts of it. Usually this procedure (biopsy) is performed through rectum, and several samples are taken at the same time. A pathologist reveals not only the presence of cancer cells, but also determines the degree of their malignancy. All cancer cells (and not only prostatic ones) are characterized by the degree of their deviation from normal. The most malignant and, therefore, dangerous are weakly differentiated cells (that is, having clear signs of a particular organ), while highly differentiated ones differ little from normal cells.
Known Prostate Cancer Treatment Methods
Prostate cancer can be treated at all stages of the disease. Currently, a patient is offered the following choice: observation without treatment, surgery (radical prostatectomy), radiation therapy (irradiation through the skin or by implantation of radioactive grains in the gland tissue), hormonal treatment in combination with radiation or without it. The use of certain treatment methods depends on the stage of the disease and the condition of a patient. So, to remove single nodes, a cryotherapy method (freezing) is developed, and with metastatic forms, anti-cancer chemotherapy is used. In general, patients with early stages of prostate cancer have the largest choice – older people with small tumors and their high differentiation are recommended to undergo observation or radiotherapy, while young people prefer surgery or radiation.
Observation without treatment
This approach to a patient in American medical practice has several names, and the most accurate will be careful observation without active treatment. In many cases, the patient’s refusal to treat cancer means suicide, but this does not apply to prostate cancer. Indeed, most prostate tumors grow very slowly, usually they do not lead to patient’s death within months or several years. There is even an opinion that many prostate cancer patients die with a tumor, but not from it.
The choice of observation without treatment does not mean that a patient is left to fend for himself: he is systematically examined by conducting a digital examination of the prostate and PSA once or twice a year. If the PSA has gone up several divisions or if a doctor detects an increase in the nodes or the appearance of new ones, an additional examination will be carried out using the ultrasound method and a computer tomography. If necessary, treatment appropriate to the stage of the disease will be offered.
Observation without treatment is most suitable for men older than 70–75 years with tumors that do not extend beyond the prostate. All other stages of prostate cancer need one or another treatment. At the time of observation, a patient is recommended a diet low in fat and high in fiber, nutritional supplements containing vitamins E, D and selenium, soy products. Of course, this will not cure cancer, but to some extent, it will restrain its development.
Surgery
Most American urologists consider the complete removal of prostate gland- radical prostatectomy, the most correct decision for a patient and a doctor. With this operation, the whole tissue of prostate gland is removed along with the capsule and tumor, which is why they call it radical. There are several options for the operation, and in the last two decades it has been carried out with the preservation of nerves passing through prostate. This avoids postoperative erectile dysfunction.
What are the indications for surgical treatment? First of all, it is carried out when the tumor is limited by the organ itself and has not gone beyond its capsule. The second condition is the degree of malignancy of tumor. Finally, the third factor is the age and condition of a patient. For people with serious illnesses, which can pose a threat to life, the operation is likely not to bring tangible benefits; the same is true for those over 80, even if their health does not cause concern. Usually, radical prostatectomy is performed under general anesthesia, and it lasts 3-5 hours. After surgery, a patient has to wear a catheter for several weeks, and a full recovery occurs in a half to two months. The operation is considered relatively safe. Of course, there is always a risk of postoperative complications, such as pain, bleeding, infections.
Radiation therapy
Unlike other forms of malignant tumors, patients with prostate cancer are offered radiation therapy at the very early stages of the disease as a method equivalent in some cases to the effectiveness of surgical removal of gland. This type of tumor grows very slowly and remains not life-threatening for a long time, and radiation acts mainly on rapidly growing (cancerous) cells, which are few in a healthy prostate. Therefore, radiotherapy may not always be a worthy replacement for surgery.
The development of radiotherapy for a long time was restrained by a purely technical difficulty – how to focus the rays so that they destroy only the cells of a tumor node and do not affect normal tissues. In recent years, this problem has been solved: now two methods of radiotherapy are developed and used. With one of them, irradiation is carried out outside, through the skin, with the other – a radioactive source is placed in the tissue of gland.
In the early 1990s, at about the same time that the PSA test was introduced into practice, scientists developed a system for irradiating the gland with several beams under the control of a computer tomography that gives a three-dimensional image of the prostate. This made it possible to focus on the tumor node large radiation energy coming in the form of three beams, each of which individually does not cause harm to healthy tissues. Treatment is carried out five times a week for up to eight consecutive weeks. With this method, the surrounding tissues and organs (bladder, rectum and colon) are not exposed to massive radiation and side effects (such as intestinal bleeding, persistent diarrhea, frequent urination and urinary incontinence) are minimal. At the same time, irradiation brings significant benefits to patients.
Hormone therapy
This type of treatment has a relatively recent history. In 1941 Dr. Charles Huggins discovered that male sex hormones, androgens, stimulate the division of prostate cancer cells, and hormone starvation slows or stops the growth of tumor. This discovery served as the basis for anti-androgen therapy and was awarded the Nobel Prize.
Testosterone in prostate cells is converted by a special enzyme into dihydrotestosterone, which binds to androgen receptors and stimulates the growth of prostate cells. The main share of all androgens is produced by the testes, but a small part is synthesized in adrenal glands. Androgen production is under complex hormonal control of brain. It is this regulation that gives rise to the growth of prostate gland during puberty, and it also causes benign prostate tumors in elderly men and the main stimulus for the growth of cancer cells.
Hormone therapy aims to reduce the total amount of male hormones (androgens) in the body, thereby putting prostate cells into a state of hormonal starvation. With a lack of androgens, prostate cells (including cancer cells) die, which leads to a decrease in the size of tumor and alleviation of many symptoms of the disease. Although the effect of hormone therapy can be quite lengthy, it still does not guarantee complete success. In many cases, a small proportion of cancer cells become independent of androgens and give rise to a new tumor, which is accompanied by a return of the symptoms of the disease. The approaches to hormone therapy are very wide, since there are many sequential steps in the regulation of androgen synthesis, which can be influenced by different drugs.
Chemotherapy
In advanced tumors with bone pain, weakness, weight loss and other symptoms, the following are prescribed: treatment with standard antitumor drugs. Although chemotherapy is difficult to tolerate in most cases, its effectiveness is high. Point irradiation is also performed to suppress the growth of individual bone metastases.