Best Treatment for Prostate Cancer?

Prostate cancer treatment is complex. Knowing which treatment will give the greatest life expectancy is a difficult decisions. Doctors and patients much choose among prostatectomy, radiotherapy, watchful waiting, hormone therapy and other treatments. Looking over past data, researchers have learned the survival rates for each of these treatments in a Swiss population.

Prostate Cancer Treatment, Longevity and LIfe Expectancy
Which Prostate Cancer Treatment Gives The Best Life Expectancy?

Prostate cancer treatments cover a wide range of approaches that impact life expectancy differently. Believe it or not, no formal clinical studies have been done to determine how best to treat localized prostate cancer. These studies would be extremely difficult to do -- they would take up to 10 years to complete, people would have to be randomly assigned to different treatment groups and the cost would be quite high. So instead, researchers have taken data from the past to compare treatments. This is called a retrospective (or historical) study. Keep in mind that there may be factors unknown to the researchers reviewing medical charts that impact the outcome.
Life Expectancy and Localized Prostate Cancer.
Swiss researchers examined the treatment and outcomes of 844 patients diagnosed with localized prostate cancer sometime between 1989 and 1998.

Five different types of treatment were applied (the "n" indicates the number of participants):prostatectomy (surgical removal of the prostate) n=158
radiotherapy (radiation treatment) n=205
watchful waiting (monitoring the cancer) n=378
hormone therapy n=72
other treatments n=31
prostatectomy (surgical removal of the prostate) n=158
radiotherapy (radiation treatment) n=205
watchful waiting (monitoring the cancer) n=378
hormone therapy n=72
other treatments n=31
Survival and Lie Expectancy in Localized Prostate Cancer.
The researchers looked at the survival rates for each group and found that at five years from diagnosis, the type of treatment made little difference to survival. When the researchers went to 10 years from diagnosis, they did find a difference in survival based on treatment. Overall, 10-year survival was:83% for prostatectomy
75% for radiotherapy
72% for watchful waiting
83% for prostatectomy
75% for radiotherapy
72% for watchful waiting
Those who had hormone risk had decreased survival rates at 5 years, but this is almost certainly because their cancer was a much more aggressive type when they were diagnosed.
Is Prostatectomy the Best Treatment for Prostate Cancer Then?
You cannot conclude that from this study. What we don't know is why certain people were given the treatment they received. It could be the Swiss doctors have a preference. For example, they might prefer a prosatectomy when the cancer presents a certain way and radiotherapy when it "looks" different. In other words, this study tells us that prostectomy is the most effective OR that doctors tend to send patients with less threatening tumors for prostectomies OR (more likely) a complex combination of both (and throw in some other factors too). Confused yet? Sorry about that. But it is important that you understand the limitations of these studies. Ask your doctor what factors he or she uses to decide on treatment and engage with that discussion.

Treatments and drugs

Hormone therapy
Hormone therapy (HT) was once the mainstay of treatment for osteoporosis. But because of concerns about its safety and because other treatments are available, the role of hormone therapy in managing osteoporosis is changing. Most problems have been linked to certain oral types of HT, either taken in combination with progestin or alone. If you're interested in hormone therapy, other forms are available, including patches, creams and the vaginal ring.

Discuss the various options with your doctor to determine which might be best for you.
Prescription medications
If HT isn't for you, and lifestyle changes don't help control your osteoporosis, prescription drugs can help slow bone loss and may even increase bone density over time. They include: 

Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown, preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of fractures. 

Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced osteoporosis. They're also used to prevent osteoporosis in people who require long-term steroid treatment for a disease such as asthma or arthritis.

Side effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if you've had acid reflux or ulcers in the past. Bisphosphonates that can be taken once a week or once a month may cause fewer stomach problems. If you can't tolerate oral bisphosphonates, your doctor may recommend periodic intravenous infusions of bisphosphonate preparations.

In 2007, the Food and Drug Administration (FDA) approved the first once-yearly drug for postmenopausal women with osteoporosis. The medication, zoledronic acid (Reclast), is given intravenously at your doctor's office. It takes about 15 minutes to get your annual dose. One published study found that zoledronic acid reduces the risk of spine fracture by 70 percent and of hip fracture by 41 percent. 

A small number of cases of osteonecrosis of the jaw have been reported in people taking bisphosphonates for osteoporosis. These cases have primarily occurred after trauma to the jaw, such as a tooth extraction, or cancer treatment. Risk appears to be higher in people who have received bisphosphonates intravenously. While there is currently no clear evidence that you should stop taking bisphosphonates before dental surgery, let your dentist know what medications you're taking and discuss your concerns.

Raloxifene (Evista). This medication belongs to a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen, such as increased risk of uterine cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene, and you shouldn't use this drug if you have a history of blood clots. This drug is approved only for women with osteoporosis and is not currently approved for use in men.

Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief from compression fractures. It's usually administered as a nasal spray and causes nasal irritation in some people who use it, but it's also available as an injection. Because calcitonin isn't as potent as bisphosphonates, it's normally reserved for people who can't take other drugs.

Teriparatide (Forteo). This powerful drug, an analog of parathyroid hormone, treats osteoporosis in postmenopausal women and men who are at high risk of fractures. Unlike other available therapies for osteoporosis, it works by stimulating new bone growth, as opposed to preventing further bone loss. Teriparatide is given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still being studied, so the FDA recommends restricting therapy to two years or less.

Tamoxifen. This synthetic hormone is used to treat breast cancer and is given to certain high-risk women to help reduce their chances of developing breast cancer. Although tamoxifen blocks estrogen's effect on breast tissue, it has an estrogen-like effect on other cells in your body, including your bone cells. As a result, tamoxifen appears to reduce the risk of fractures, especially in women older than 50. Possible side effects of tamoxifen include hot flashes, stomach upset, and vaginal dryness or discharge.

Emerging therapies
A new physical therapy program has been shown to significantly reduce back pain, improve posture and reduce the risk of falls in women with osteoporosis who also have curvature of the spine. The program combines the use of a device called a spinal weighted kypho-orthosis (WKO) — a harness with a light weight attached — and specific back extension exercises. The WKO is worn daily for 30 minutes in the morning and 30 minutes in the afternoon and while performing 10 repetitions of back extension exercises.