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Stephan L. Werner, M.D., F.A.C.S. The choice of what type of therapy is appropriate for a patient with Prostate Cancer: radical prostatectomy, radiation, seeds, combined therapy, observation, cryotherapy or hormonal therapy, is dependant on many factors including: the Gleason Grade and the Stage of the cancer; the patient's age; the patients medical condition; and the patient's desires. There is no absolutely right or wrong way to treat every patient, and what is appropriate for one patient may not be so for another. In general prostate cancer tends to be less aggressive with increasing age of onset. Indeed, prostate cancer discovered when the patient is over 80 years of age tends to be slow growing, and is usually observed or watched, and treated only if the cancer seems to be growing aggressively. Similarly, patients with other severe medical conditions who are discovered to have prostate cancer may be best observed, and treated only if the prostate cancer is aggressive. Some patients with lower grade, (Gleason 2 - 5) and or very small amounts of cancer found in the gland may elect observation. The risk of developing metastases and incurable disease must be balanced against the desire to avoid treatment. Younger, healthy prostate cancer patients with curable disease, Stage A, Stage B, and some early Stage C, should be treated aggressively with either surgery, or varied forms of radiation, such as conformal external beam, seed implantation, (brachytherapy), or combined therapy, or possibly with cryotherapy. Classic thinking has been that over the long run, surgery provides a slightly better chance for cure, and should be favored in younger healthier patients. However recent data suggests no great difference between surgery or radiation up to 12 Years. In some cases where there is a high suspicion of local spread: Stage C, or Gleason grade 7 or 8, or a PSA over 10, surgery followed by radiation or combined brachytherapy and external beam irradiation with or without hormone therapy may be indicated. Patients age 70 to 79 or patients with other serious, life threatening diseases, should be treated with one of the forms of radiation therapy, cryotherapy, or in some cases, observation Sometimes, neoadjuvant, short term hormonal treatment, used in combination with radiation treatments is appropriate. Historically Prostate cancer patients with advanced cancer: Stage D, or extensive Stage C, disease were best treated with hormonal therapy. While not curing prostate cancer, hormonal therapy frequently slows its course and prolongs life and comfort. However, recent research suggests that aggressive treatment of the local cancer, with surgery or combined: hormone therapy, external beam irradiation and seeds, PLUS long term hormonal suppression significantly increases life expectancy and cancer free survival. This is a major change in therapy. Patients with Gleason grade 8, 9 or 10 have high risk cancer. Treatment is controversial. Historically, aggressive treatment was not offered, however recent studies suggest that early aggressive treatment with combinations of surgery or radiation along with long term early hormonal therapy, with or without taxane based chemotherapy may increase survival or disease free periods in these cases. There is no one "right" way to treat any one patient, and a discussion with the urologist, is necessary to arrive at an appropriate treatment plan. Rev: 09/04
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[Home] Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc Greenbelt - Bowie - Laurel Maryland (301) 441-8900 Fax (301) 982 0453 7500 Hanover Parkway Suite 206 Greenbelt, MD 20770
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