Best Treatment Option of Prostate Cancer

IADT3since2000

Hi ak773,

I'm sorry that you have "joined our club," but it appears you have caught the disease early, which is good of course.

Could you tell us about your access to care, as that has some bearing on your best options. For example, if there is a great prostate surgeon in your area but somewhat out-of-date radiation available, then surgery would be a more attractive option, and vice versa if superior radiation but poor surgery were available. I am not familiar at all with prostate cancer treatment resources in Dhaka or in all of Bangladesh. On the other hand, my impression is that there are some excellent resources in Singapore.

Initial key characteristics of prostate cancer are Gleason grade (yours is mild at GS-6, consistent with active surveillance), PSA (yours is in the good range at 6.83 - especially with some benign prostatic hyperplasia, which would account for some non-cancerous PSA and therefore a lower amount due to the cancer, again consistent with active surveillance), and stage (not stated). Could a nodule be felt in the usual digital rectal exam? Your data from imaging and biopsy is not clear to me: did you have a total of 7 cores taken (1 from the right lateral and 6 from the left lateral, or more, which would be typical, at least in the US)? Many doctors and researchers believe that a third or fewer cores positive is a good sign, but 3 out of a total of 7 positive would contribute to concern. The 20% volume for the cores is good. Your imaging is consistent with a mild case but does not rule out a stealthy aggressive case.

Overall, at this point, it looks like you are eligible for all sound options, especially including active surveillance (You are not too young.), radiation, and surgery. Cryosurgery is still fairly investigational, though in good circumstances it appears to work well. HIFU (High Intensity Frequency Ultrasound) looked good to many of us but then research from all over the world came in indicating that by the fourth and fifth year patients were not doing well compared to how patients did on other options, with one exception – the Uchida team in Japan, which uses a special combination of technologies to do its HIFU.

Whatever you choose, supportive lifestyle tactics appear to make a substantial difference. They include diet and nutrition, strength and aerobic exercise, and stress reduction. Medications that are fairly inexpensive and well tolerated by most of us also appear to be important in support of many patients without regard to treatment. Metformin, an old drug for diabetes, is getting a lot of interest these days for prostate cancer support; dosing can be adjusted to avoid side effects apparently. A statin drug also should help, and most of us tolerate statins well. Rounding out this trio would be one of the 5-alpha reductase inhibitors, either finasteride or dutasteride, sold as generics or under the brand names Proscar and Avodart in the states. The medical evidence behind these drugs for prostate cancer is very interesting and encouraging, but it is not yet strong enough to make them part of the standard of care.

Do you know much about the therapy options? Do you have specific questions?