For U.S. Healthcare Professionals Only
Classically, prostate cancer has been considered advanced
when there are signs of distant spread to either lymph nodes or bone. More recently
we have become aware that locally extensive disease, that is, disease outside the
prostate including disease involving the seminal vesicles, is advanced disease.
In addition, patients who have rising prostate-specific antigen (PSA) after local
therapy are considered to have advanced prostate cancer.
In discussing advanced prostate cancer with my patients and their caregivers, I
tell them that the implications of advanced prostate cancer, including what therapy
would be appropriate, depend on a number of factors. These include the patient's
age, any comorbidities, how aggressive their cancer is as determined by their initial
Gleason score, and the previous therapy they have had. I work with my patients to
use these parameters to develop a therapeutic plan.
I discuss the major side effects of each therapy I offer them. For cryosurgery I
discuss fistulae, incontinence, and urgency. For hormonal therapy I mention hot
flashes, weight gain, and osteoporosis. If I am offering them chemotherapy, I talk
about the standard side effects of nausea, vomiting, and malaise.
After starting my patients on therapy, I monitor their PSA levels, testosterone
levels, and alkaline phosphatase levels. For patients on an LHRH agonist, I follow
bone mineral density tests. Patients who are given an antiandrogen have their liver
function tests monitored.
If the patient's physical, mental, and disease status warrants it, I may suggest
a clinical trial, however, clinical trials are not for everyone. If the patient
desires to be part of a trial, I will help him enroll.