when a man is newly diagnosed with
prostate cancer there are a few options you can choose from in terms of treatment which factors
should be considered before deciding on treatment The majority of men are diagnosed with what we call
localized prostate cancer meaning that cancer has not spread beyond the gland while some of them might live forever and never die of the cancer even
without treatments other will have much more aggressive
disease and will need to be more aggressive treatment up front in order to stratify the patient and
different risk categories to guide them through
treatment we have used clinical parameters such as
the serum PSA the Gleason score which is found under biopsy results as well as the extent clinically through rectal exam
and imaging to building prognostications system that
will guide our treatment based on these three factors we have pieces with low risk of disease progression
intermediate and high-risk. For patients with very low
risk Active surveillance is actually a recommended modality meaning are close follow-up serial psh X and repeat biopsies and treatment at the
time of disease progression patients who have
low-risk disease can choose in selected cases between active surveillance or treatment
with radiation or radical prostatectomy patients with intermediate great disease probably
should not observe and the silent treatment with
either radiation or surgery and if the choose to undergo
radiation therapy should be treated with six months of hormone deprivation therapy high-risk patient meaning those who are
at the highest risk for progression and the task to seize up should either under undergo prostetectomy or if they choose to have radiation therapy will combine this
with two to three years of androgen deprivation how to choose between surgery or
radiation will depend on the patient profile if
the patient is not good a good surgical candidate because of
other core morbid conditions he has such as heart disease diabetes or advanced
age then treatment is likely to be radiation
with or without hormone deprivation a younger fifth patient for example in
his fifties was no other medical issues and a very
aggressive disease might probably benefit more from
up-front surgery the side effects Associated with radiation and surgery are explained by the technique and I will explain to you
in a second with surgery the main goal for quality of life is to try to preserve the nerve bundles
that mediates sexual function so for the surgeon who performs this
procedure the question is can I preserve the nerve
bundle safely meaning without leaving any
disease behind this should be discussed with the
patient prior to the procedure based on the risk level the search you
will also entail removal of lymph nodes in the pelvis which might cause some problems down the
road such as edema if the so called urinary sphincter muscle is affected during the surgery the patient
might suffer from incontinence after the
surgery most of these a side effects will
improve over time by about two years after
surgery depending on what study will look at
thirty to fifty percent of patients will have some decrease of these
functions although they are not very severe it’s important
to know that for example sickle cell dysfunction can
be treated with implants and medication so a counseling the patient is very
important to know that we are able to control most of the side effects
patients who elect to undergo radiation will have more acute side effects such
as irritable bowel that is in the radiation
field and is a manifested by up frequent bowel
movements urgency and sometimes also a rectal
bleeding but again these are acute side effects and most
of them resolve over the first one to two years the urinary
symptoms that patients who undergo radiation experience are explained by what we call the
radiation cystitis so it’s more the irritation of the
blather rather than are interaction with the sphincter
muscle so again they will have emergency
meaning they have to go to the bathroom a lot have some burning sensation but this over time will improve as well sexual
dysfunction on the other hand is a side effect there
will develop over time and the increased typically over the
first one or two years in patients who undergo radiation but if
you look at two years in most studies there is not a
major difference in terms of long-term side effects of
surgery of this radiation in the majority of men so other medical problems as mentioned
earlier will help guide the decision-making some prostate cancers are high-risk
aggressive and more likely to spread others are low-risk least likely to have
bad outcomes the biopsy says cancer but current
diagnostic tools provide limited information about how aggressive the
men’s individual disease is so most men decide to treat prostate
cancer immediately once treated many men experience serious long-term
side effects like incontinence and sexual impotence
immediate treatment isn’t always needed but right now a man can’t be sure if his cancer is the kind that is likely to require treatment or if he’s okay to wait for now what if
there was a test that could determine how aggressive
prostate cancer is genomic health is developing a new test
to do just that by reviewing the underlying biology of
the tumor and using genes from multiple biologic pathways the test can predict the aggressiveness
of prostate cancer when diagnosed allowing a man to make a more informed
treatment decisions with confidence taking care of himself with more
information and greater piece of mind.

4 thoughts on “Choosing the Right Prostate Cancer Treatment”

  1. Hi Doctor, Your video did not mention immunotherapy for prostate cancer. I was treated with immunotherapy. I have had stage 4 prostate cancer for 10 years. Gleason 8-9 two different pathologist . Pain – I could not sit down, to eat my dinner NOW-all the pain is gone 100%—- Pee stream very week -was going to have a turp NOW pee stream is better than normal—no turp —–Severe fatigue napped all day and night—-NOW great energy

  2. The most potent drug to cure either long battled or newly diagnosed prostatitis is SULFA- P ALISHECH of Israel. When it was first introduced to me by my physician, I doubted its therapeutic potency not until when I bought and used it. Many years of suffering from prostatitis cured like magic.

  3. Active surveillance I will recommend, but repeat biopsies is bad idea. Biopsy is a terrible idea as it damages the prostate and causes cancer

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