Zerbib and colleagues (Urology – Dec 2008 ; 72 (6 Suppl):p25-35) reviewed these diverse possibilities of treatment to indicate what choices are available for men today presenting with low risk prostate cancer.
Here are their conclusions:
- The risk of cancer spread during a period of watchful waiting depends on tumor stage and GLEASON score at the time of diagnosis.
This choice of watchful waiting is possible with safety, over a period of 5 to10 years, for men presenting with low risk prostate cancer.
However, the growth rates of low risk prostate cancers were not estimated beyond 10 years in current studies.
- Patients presenting low risk tumors can be included in watchful waiting protocols without giving up at the appropriate moment a possible curative treatment and without taking an unreasonable risk of disease progression, although certain patients will not agree psychologically to live with an untreated cancer.
Zerbib and coll. suggests that focal therapies can represent a good alternative to watchful waiting for some patients presenting with low risk cancer, if they can limit the unwanted effects on their quality of life.
- Radical prostatectomy is an effective treatment for patients presenting with developed prostate cancer ; however, the functional results are very dependent on the surgical technique.
Because of perioperatives complications risks and of urinary and sexual side effects, which seem identical with the robot assisted laparoscopic prostatectomy (RALP) than with any other technique, the patients presenting low risk cancer, in particular those who are past sixty, are easily attracted by more conservative alternate solutions.
- The external beam conformational radiation therapy is an effective – non surgical – treatment, but it carries significant long-term risks of intestinal disorders and, sexual and urinary dysfunctions.
It could be too aggressive for many low risk cancers. For the more aggressive cancers, the recurrences after radiation therapy are responsible for high morbidity rates but the long-term control of the cancer seems an inferior risk.
- Brachytherapy or interstitial radium therapy is a practical and effective radiation therapy, ideally reserved for patients presenting a limited cancer situated in a prostate under 60 grammes of weight without any evidence of extra – prostatic invasion on the pre-treatment imaging evaluation.
However, excellent results requires an accurate technique: acute urinary symptoms are frequent; and the long-term risks of rectitis and erectile dysfunctions are identical to those of external beam radiation therapy .
- The hormonal treatments by androgenic blockage are not recommended to patient’s presenting with localized prostate cancer as an alternative to surgery or radiation therapy, because, even administered on a short term period, they carry an important risk of side effects, in particular osteoporosis and severe cardiovascular accidents.
In locally advanced prostate cancer, the hormonal androgenic blockage should be used only to relieve discomfort in relation with urinary symptoms for men with a life expectancy under 5 years, to whom we cannot offer a more aggressive treatment.