| Quest For Answers |
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PROSCAR BEFORE SURGERY Q: Considering the recent results of the study showing a more aggressive form of
prostate cancer in men who have taken Proscar, would you now consider it advisable to
use Proscar to retard cancer growth while, for example, waiting for a pending
prostatectomy? I no longer recommend that men take Proscar on a long-term basis. The effect of short-term administration of Proscar in men with established prostate cancer who are waiting for surgery is uncertain. Certainly, it is possible that in this setting, Proscar could retard only the less aggressive cancer cells while the more aggressive ones continued to grow and spread unchecked. OVERDETECTION Q: I read an article about a study that said annual prostate cancer screening is
tied to a high overdetection rate. How do you respond? It is harder to show a benefit in older men who are more likely to die of another cause first. Nevertheless, many older men develop aggressive prostate cancer that ultimately kills them in a very painful way. Statistical models for overdetection do not take into consideration the clinical judgement of a well-informed doctor and patient regarding the risk-benefit ratio of screening for prostate cancer. Also, not every patient with prostate cancer has to be treated. Knowledge is useful, and it is usually beneficial to know whether cancer is likely to be present and whether there are signs of progression, such as a rising PSA level, so appropriate intervention can take place, if indicated. Some "overdetection" takes place with any cancer screening program, but good clinical judgement can usually prevent this occurence from harming the patient. CONTAINMENT AND RECURRENCE Q: How can prostate cancer recur if it was totally contained within the prostate
gland? Therefore, there is always a risk for recurrence, no matter how favorable the pathology report, which is why all patients are advised to have follow-up visits. If everything looks clean on the pathology report, a 5-30% chance of recurrence is still possible, depending upon the Gleason grade and tumor volume. PSA REPEATEDLY IN CONCERNED ZONE Q: What should a man do if he has had repeated negative biopsies but his PSA test is
in the concerned zone? I have had six biopsy procedures, initiated with PSA's from 8-19,
and all have been negative. It is important to stay under the care of a urologist and make sure you go in for scheduled tests and check-ups. These may include repeated biopsy sessions, especially if the PSA continues to rise, as biopsies are only small samples of the prostate gland, and it is not infrequent that initial biopsies miss the cancer. INTERMITTENT OR CONTINUOUS HORMONAL THERAPY Q: I need to go on hormonal therapy following radiation treatment. I've been told I
have a choice of intermittent or two to three year continuous treatment. How are they
different? The advantage of the intermittent therapy is that the patient takes the hormonal therapy until the PSA goes to zero and then stops until it drifts back to 4 and then goes back on it until the PSA goes to zero again. With the intermittent therapy, men are only on hormonal therapy about half the time of those on continuous treatment. The important question to answer is: Is intermittent therapy as effective as continuous hormonal therapy? And this year a study from Europe showed that the men on intermittent hormonal therapy actually did better than men on continuous therapy. I think intermittent therapy is a good choice for most men and does spare some of the side effects of the continuous therapy. Some men can stay off therapy for two or three years before they have to start again. MEDICARE COVERAGE OF PSA TESTING Q: Does Medicare or Medicaid cover the PSA screening test? LUPRON, CASODEX AND THEN WHAT? Q: How long will Lupron and Casodex work and what comes after they don't? I usually tell men starting hormonal therapy about my most successful patient – who at the time he was diagnosed had cancer spread to his bones and all over his body, and he was not a candidate for surgery or radiation. He was placed on hormonal therapy and his PSA remained undetectable for 19 years. Some men will stay in a remission for long periods of time – 10, 12, or 15 years – and there are other patients for whom the time will be much shorter. The remission time is completely unpredictable in individual patients. If the PSA rises while on Lupron and Casodex, other types of hormones are available and a more effective form of chemotherapy is also available. In the pipeline are new experimental treatments involving immunotherapy, gene therapy. They are not ready for "prime-time" now, but in three to four years from now may offer better and more effective treatments with less side effects than treatments we have now. COLD AFFECTING PSA Q: Can cold or cough medication affect the PSA level? |