Total Commitment
Even the experts face a dizzying range of options for treatment of prostate cancer. Treat it or watch it? Surgery, radiation, or hormone therapy? Traditional radiation or TomoTherapy? Surgery with or without robotic assistance? If the experts themselves can’t agree, what’s a prostate cancer patient to do?
“I try to impress upon people that prostate cancer is a complex disease that comes in various forms,” says Christopher Amling, M.D., director of UAB’s Division of Urology. “There are challenges in selecting treatment, and there are challenges in terms of deciding how we cure this cancer, particularly in men with higher-risk disease.” Men with the more complicated and aggressive form of prostate cancer may need what’s called a multimodal approach, “meaning that surgery alone or radiation alone may not be adequate to cure the cancer,” Dr. Amling says.
“A multidisciplinary approach allows all of us to get together in the same clinic and talk,” he adds. “That way, if necessary, we can recommend a combination of surgery followed by radiation, radiation with hormonal therapy, or chemotherapy with hormonal therapy.”
Patients at UAB’s Multidisciplinary Prostate Cancer Clinic find urologists, medical and radiation oncologists, and nurse practitioners on hand to help determine the ideal treatment options for their circumstances. “It allows them to see all of us together in one clinic and get our opinion on how their particular cancer would be best treated,” Dr. Amling says.
One main focus of the Prostate Cancer Clinic is educating men about the various aspects of prostate cancer, particularly risk factors, awareness, and screening. “Most of the people we see come in with a lot of information because they’ve been online at the National Cancer Institute and the American Cancer Society sites,” Dr. Amling says. “A lot of them are confused because this is a very complex cancer. We try to get the word out in the community on the importance of screening and early detection of prostate cancer, because we think that’s the best way to get it cured.”
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To Test or Not to Test? Understanding Prostate Screening Guidelines The American Cancer Society recommends that men undergo screening every year beginning at age 50. “At UAB we recommend that screening begin at 40 for men who are at higher risk and for African-American men with a family history of prostate cancer,” Dr. Amling says. “There’s even some push for all men to get a screening PSA [prostate-specific antigen] test and a digital rectal examination sometime in their 40s and not wait until they’re 50 to start it.” If prostate cancer is found, a number of treatment options are available. One common option is known as active surveillance or “watchful waiting”; doctors simply keep an eye on the tumor to monitor its progress. Prostate tumors tend to grow slowly and stay confined to the prostate, so particularly in older patients, doctors sometimes choose not to treat prostate cancer at all unless it looks threatening. However, “when we find men with cancer at younger ages, those cancers are likely to be problematic over their lifetimes, and we advocate that those cancers are treatable and curable,” Dr. Amling says. “So in general, in younger men we advocate curative treatment.” When treatment is the best plan, the two main curative options are radiation and surgery. Radiation can take the form of radioactive seeds implanted in the prostate, called brachytherapy, or beams of radiation targeted at the tumor, called TomoTherapy. For surgery, UAB is equipped with two da Vinci surgical robots, which offer less pain, blood loss, and risk of infection than regular surgery. To learn more about da Vinci surgery, see “Less is Best” |
