Treatment options for the most common cancer in men
Posted on 11 October 2019
When detected early, there is a 90% cure rate for prostate cancer. Discover more about the importance of screening – and the treatment options available.
As Dr Andre Dreyer, an oncologist at Mediclinic Panorama and Cancercare Panorama Oncology Centre, says, prostate cancer is the most common cancer in men across all races, and although young men can get it, the risk increases with age. ‘If it runs in the family, it can affect men from the age of 35 onwards. However, it mostly occurs after 50 and is more common after 70 years of age.’
Risk factors include a family history of prostate or breast cancer, as you may have a gene that causes prostate cancer to occur. ‘Although we don’t have accurate statistics for South Africa, African Americans are more likely to contract prostate cancer than Europeans,’ Dr Dreyer says.
One of the concerns about prostate cancer is that there are no early warning signs. ‘Later signs will include blood in the urine, more difficulty during urination and pelvic pain or backache from metastatic disease,’ he adds.
To screen for prostate cancer, men should have yearly PSA tests and digital rectal examinations from the age of 50, unless family history suggests early screening is needed.
The PSA test is a blood test that measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. It’s normal to have a small amount of PSA in your blood, and the amount rises slightly as you get older and your prostate gets bigger. A raised PSA level may suggest you have a problem with your prostate, but it does not necessarily signal cancer.
Dr Dreyer cautions that because 10% of prostate cancer patients don’t have raised PSA levels, it is vital to have regular digital rectal examinations too because blood tests alone won’t detect the cancer.
‘There is a group of prostate cancers that don’t need treatment – and can be followed up with medical visits – but 45% of those patients will need treatment later on,’ Dr Dreyer explains. ‘In younger patients it’s not effective just to follow up because within five to 10 years they will need treatment and the cancer will then be at a more advanced stage. Follow-ups are only for older people with slow-growing cancer.’
For patients with localised prostate cancer, the choice of treatments includes follow-ups and surgical removal of the prostate.
‘Laparoscopic surgery or robotic laparoscopic surgery to remove the prostate shows good results and a low incidence of incontinence following the procedure,’ Dr Dreyer explains. However, surgery may be inappropriate for those with locally advanced disease and certain medical conditions.
Prostate radioactive seed implants, known as brachytherapy, carry high cure rates and fast recovery times, Dr Dreyer says. With this method of treatment, up to 55 small radioactive seeds are permanently planted in the prostate and a margin of a few millimetres of surrounding tissue. This concentrates the radiation on the cancer cells and lessens radiation damage to some of the normal tissues (organs at risk) near the cancer. Patients who have trouble urinating are not good candidates for this treatment as swelling can make bladder functioning even worse for the next few months.
‘External beam radiotherapy is suitable for patients who aren’t fit for surgery or implants. This entails 30 to 35 well-focused, localised radiotherapy treatments that administer optimal doses of radiotherapy to the affected area without compromising the surrounding normal tissue. This is usually a six- or seven-week course of five days a week and is well tolerated,’ Dr Dreyer says. ‘It has a good outcome and low side effects on bladder function.’
In cases of more locally advanced prostate cancer, doctors will generally prescribe a combination of anti-hormonal treatment, surgery and radiation, or implant and radiation. This decision is made in conjunction with the patient, an oncologist and a urologist.
‘When treating early cases of prostate cancer, the cure rate is 90%,’ Dr Dreyer says. In locally advanced cases, the cure rate is 75%. When prostate cancer is advanced, treatment focuses on improving the patient’s quality of life and may entail blocking hormones, chemotherapy and sometimes radiation.’