Prostate Cancer (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dennis Lee, MD
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
In this Article
- What is the prostate gland?
- What is prostate cancer?
- Why is prostate cancer important?
- What are prostate cancer causes?
- What are prostate cancer symptoms and signs?
- What are the screening tests for prostate cancer?
- What are false-positive elevations in the PSA test?
- What refinements have been made in the PSA test?
- How is prostate cancer diagnosed?
- How is the staging of prostate cancer done?
- What are the treatment options for prostate cancer?
- What about prostate cancer surgery?
- What about radiation therapy for prostate cancer?
- What about hormonal treatment for prostate cancer?
- What is cryotherapy for prostate cancer?
- What is HIFU for prostate cancer?
- What is chemotherapy for prostate cancer?
- What are the differences between hormonal treatment and chemotherapy?
- What about herbal or other alternative medicine treatments for prostate cancer?
- What is active surveillance for prostate cancer?
- Can prostate cancer be prevented?
- What will be the future treatments for prostate cancer?
- Prostate Cancer At A Glance
- Find a local Oncologist in your town
What about herbal or other alternative medicine treatments for prostate cancer?
Alternative medicine, also called integrative or complementary medicine, includes such non-traditional treatments as herbs, dietary supplements, and acupuncture. A major problem with most herbal treatments is that their composition is not standardized. Moreover, the way herbal treatments work and their long-term side effects usually are not known. Currently, there is no evidence to prove that these medications have any therapeutic benefit in prostate cancers that have become resistant to conventional treatments.
What is active surveillance for prostate cancer?
Active surveillance is observing a patient while no immediate treatment is given. Such a patient usually has a less aggressive, small-sized, organ-confined tumor and no symptoms. This management strategy is based on the premise that most early prostate cancers are slow-growing tumors and will remain confined to the prostate gland for a significant length of time. This implies that in selected patients it may be possible to defer definitive treatment for many years or avoid it altogether thereby preventing the side effects associated with treatments like surgery or radiation. Understand, however, that although active surveillance involves no actual treatment, the patient still needs close follow-up and monitoring. The follow-up involves frequent visits to the doctor, perhaps every three to six months. The visits include questions about new or worsening symptoms and digital rectal examinations for any change in the prostate gland. In addition, blood tests are done to watch for a rising PSA, and imaging studies can be conducted to detect the spread of the cancer. Most experts also recommend performing a confirmatory set of prostate biopsies to ensure that there is low-volume disease. Additional prostate biopsy is required every year to detect any increase in the volume and Gleason grade of the cancer. As mentioned before, Gleason grade is a measure of aggressiveness of the tumor and increase in this value may point toward a need to treat the cancer with other means. If the history, examinations, or any of the tests signal the possibility of an advancing cancer, the active surveillance usually is discontinued and active treatment is recommended, often with radiotherapy or surgery.
Active surveillance is different from watchful waiting. Watchful waiting means following up patients without any tests or biopsies and treating them only when symptoms arise. This is reserved for men who have a life expectancy of less than 10 years. Therefore, watchful waiting seems to make sense for organ-confined (localized) prostate cancers in men who are elderly. Additionally, watchful waiting often is the most appropriate choice in men who are ill with other serious medical diseases, such as heart or lung disease, poorly controlled high blood pressure, diabetes, AIDS, or other cancers.
Active surveillance and watchful waiting in prostate cancer, however, remains controversial. Some medical authors have stated outright that it is not a good choice. They point out that few doctors would just watch other cancers to see whether they would spread without treatment. Furthermore, the treatment for an individual could become less effective in the future if and when the cancer does progress. Moreover, there is no standardized protocol for selecting appropriate patients for active surveillance with different institutions having their own different guidelines. Studies are under way to compare these protocols with more established methods of treatment, and more information is likely to emerge in the future.
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