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HOUSE CALL: Prostate cancer treatment offer range of options


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By Dr. Brad White STLtoday.com | Posted: Wednesday, August 10, 2011 6:00 am

Prostate cancer remains the second-leading cause of death in men.

It occurs when a tumor develops in this walnut-sized gland that sits below the bladder and in front of the rectum. The gland's main purpose is to provide protective fluid to support sperm survival.

When deciding on a treatment, men should be well informed of the risks and benefits of all treatment options. Treatments include everything from observation to removing the entire gland. The stage and grade of the cancer should be taken into account.

More treatment options are available for lower-stage and low-grade cancers. With advanced or metastatic prostate cancer, which has spread outside the prostate gland and has little chance of cure, treatment is often focused on slowing cancer growth.

Age, life expectancy and other medical disorders are important issues when considering treatment. Men 72 and older, and those with significant medical problems, are more apt to succumb to another illness before prostate cancer impacts their life. Complications and side effects of prostate cancer treatment may also discourage the patient from considering a complete cure.

There are several curative treatment options for prostate cancer. The two methods most used are surgery and radiation.

Surgical options for prostate cancer include open-incision procedures and laparoscopic procedures, the latter of which are done with thin instruments and require a smaller incision.

Risks of surgery include bleeding, infection, rectal injury, erectile dysfunction and incontinence. Laparoscopic surgery usually reduces blood loss, the length of the patient's hospital stay and the amount of time off work. There's no significant difference in erectile dysfunction and incontinence rates with open-incision versus laparoscopic surgery. 

Radiation therapy can be delivered in a few ways — external beam, radiation seed implantation and proton beam. External beam radiation therapy involves multiple short treatments, about 40. Seed implantation, called brachytherapy, is a single-placement treatment in which high-intensity radioactive seeds are placed into the prostate.

Common side effects include irritability to the bladder and rectum. With radiation therapy, there's fewer occurrences of bleeding, infection and incontinence. The rate of erectile dysfunction therapy is similar to surgery.

Because prostate cancer is a slow-growing cancer, men who are apprehensive about the side effects of treatment can choose to have their cancer actively monitored instead of undergoing surgery or radiation treatment. Prostate-specific antigen (PSA) exams and biopsies are a part of this monitoring. If the cancer grows or becomes more aggressive, then curative treatment is recommended.

Prostate cancer is typically diagnosed by a urologist; consultation and second opinions by other specialists should be considered and welcomed.

Dr. Brad White is a urologist on staff at Missouri Baptist Medical Center.

Groups to offer free prostate cancer screening

The St. Louis Men's Group Against Cancer and Fox 2 are partnering with Missouri Baptist Medical Center and Urology Consultants Ltd. to provide men with free prostate cancer screenings. The screenings will be done from 8 a.m. to noon Saturday, Sept. 17, at the East Pavilion of Missouri Baptist Medical Center, 3015 N. Ballas Road.

Candidates for the screening are men 50 and older — or 40 and older for African-Americans — who have a family history of prostate cancer, have not been diagnosed or treated for prostate cancer, and are not currently participating in a prostate-specific antigen (PSA) study.

The screening includes a PSA blood test and digital rectal exam. Advance registration is required. Call 314-996-LIFE or 1-800-392-0936. Visit www.missouribaptist.org for a campus map

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