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Locally advanced prostate cancer is generally defined as a prostate cancer that has invaded local tissue, but not spread to lymph nodes or to other distant areas. Patients commonly ask questions about locally advanced prostate cancer, how to treat it, and its prognosis.
What is the best treatment for locally advanced prostate cancer?
Until the past several years, locally advanced prostate cancer was not treated with multimodal therapy. In fact, there has been a debate as to whether or not to even start androgen deprivation therapy in patients with only locally advanced disease. While there is a small survival advantage toward early treatment, this needs to be weighed against potential side effects.
In a 10-year study, 1,205 men were treated with androgen deprivation therapy (ADT) alone or with ADT plus radiotherapy. After 6 years of follow-up, 51 of the 603 men receiving the combined therapy had died, compared with 89 of the 602 men who received ADT alone. The combination treatment decreased the risk of death from prostate cancer by 43% in men with locally advanced disease.
In a similar European study, 875 men with locally advanced prostate cancer were randomized to either receive hormonal therapy or hormonal therapy plus radiotherapy. After 7 years of follow-up, 18% of men in the hormone therapy treatment had died, while 9% of men in the combination group died. Ten-year mortality was 50% lower in the combination therapy group.
A number of different characteristics can place you into a low-, intermediate-, or high-risk category. Patients classified as either intermediate or high risk are candidates for a multimodal therapy, while low-risk patients may not be.
Low-risk patients are those with disease confined to one lobe of the prostate, a serum PSA <10 ng/mL, and a Gleason score ≤6. Intermediate-risk patients either have disease in both lobes or more than one half of one lobe. Additional features include a serum PSA between 10 and 20 ng/mL or a biopsy Gleason score 7. Finally, high-risk features include disease that extends out of the capsule or outer covering of the prostate on physical exam or a serum PSA >20 ng/mL, or a Gleason score of 8 to 10.
Alternative medicine and locally advanced prostate cancer
More than 18 to 45 percent of all prostate cancer patients admit to using alternative medicine at some point. It is really important to discuss any additional therapies with your doctor. One study combining vitamin D with docetaxel, a chemotherapy drug for locally advanced prostate cancer, found excess mortality.
On the other hand, lycopene, a very common ingredient in red sauces and tomatoes, may benefit a small group of men with metastatic prostate cancer who have not had radiotherapy or hormone therapy but who have had orchidectomy. The evidence for alternative therapy at this point is pretty small, but many studies are ongoing.
Make sure you discuss all your treatment options with your doctors and let them know if you are taking any alternative or nontraditional treatments.
Read more in our Prostate Cancer Health Center.
Australian Cancer Network. Accessed July 14, 2013. Clinical practice guidelines for the management of locally advanced and metastatic prostate cancer.
Warde P et al. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet 2011 Dec 17; 378(9809): 2104-11
Widmark A et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. The Lancet 2009 Jan 24; 373(9660): 301-8
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