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Prostate Problem Guide
Are Prostate Cancer Patients Being Over-Treated?
Many thousands of men are treated for early prostate cancer every year with the majority either undergoing surgery or radiation treatment. However, it is now being suggested that perhaps as many as half of those men treated would have fared just as well if their prostate cancer had simply been monitored.
Prostate cancer normally develops late in life and although many men in their forties contract the disease, it often does not develop until men are in their sixties or even seventies. Additionally, many prostate cancers are slow growing and a significant number of men die from other causes before their cancer becomes a real problem. As a result, it is often felt that it is advisable to adopt a policy of simply watching and waiting and to only intervene when it becomes necessary.
This policy however produces two specific problems.
The first problem is that when prostate cancer is found at an early age many men are unhappy with a policy of watchful waiting. Sometimes this is simply a matter of finding it unacceptable to live with the knowledge that they have cancer, but often it is a case of feeling that, as the cancer has been found at an early age, it is fairly likely that treatment will be necessary at some point in the future and so it is better to sort the problem out now while they're still young and otherwise in good health.
The second problem is that there is presently no clear way of telling just when treatment should be undertaken. The available tests such as the Gleason score, the prostate specific antigen (PSA) test, ultrasound examination and biopsy all give doctors valuable information, but none of these tests give any real indication of how the cancer is likely to develop and at what point a reasonably small and slow growing cancer might become aggressive.
ANDROGEN RECEPTOR MUTATION (ARM): a mutation in the gene located on the androgen receptor that allows the anti-androgen to stimulate prostate cancer growth rather than block growth; a paradoxical effect usually occurring in about 30% of patients on long-term anti-androgen therapy in the setting of a rising PSA with a castrate testosterone level.
EXTERNAL BEAM RADIATION THERAPY (EBRT): a form of radiation therapy in which the radiation is delivered by a machine directed at the area to be radiated as opposed to radiation given within the target tissue such as brachytherapy.
IMMUNE SYSTEM: the biological system which protects a person or animal from the effects of foreign materials such as bacteria, viruses, cancer cells, and other things which might make that person or animal sick.
REMISSION: the real or apparent disappearance of some or all or the signs and symptoms of cancer; the period (temporary or permanent) during which a disease remains under control, without progressing; even complete remission does not necessarily indicate cure.
Today, it is often a matter of monitoring prostate cancer until symptoms appear and then, instead of managing the symptoms, to treat the cancer itself at this point. In a significant number of cases however it could be argued that the symptoms can be treated fairly easily and that cancer treatment, often accompanied by unpleasant side-effects, is unnecessary at this point.
In some cases treatment would of course be needed at a future date, but in many men the development of the disease would continue at a slow pace and death from other causes would occur before treatment became necessary.
The solution to this problem lies in developing a method for assessing the growth of prostate cancer so that doctors can tell with far more accuracy whether prostate cancer presents a significant risk in individual patients. Studies are now underway to find such a solution and it is hoped that an answer will be found before too long.
While we are waiting for a solution to this problem, if you are diagnosed with early stage prostate cancer then you should think carefully about the best course of action before simply rushing into what may prove to be unnecessary treatment, together with all its side-effects.
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