ANNOUNCER: Prostate cancer can be locally advanced or can spread beyond the prostate to involve other organs, and especially the bone.
As the disease progresses, symptoms will occur, but early on, many men may experience little to no symptoms related to the cancer.
ARNOLD BULLOCK, MD: In fact, most people who have symptoms, such as a slow stream or getting up at night, that's attributable more to obstructive prostate problems or bladder dysfunction than it is to prostate cancer.
ANNOUNCER: Men are initially diagnosed and treated by urologists, but as the cancer progresses, treatment becomes a multidisciplinary affair for physicians.
CELESTIA S. HIGANO, MD: We tend to work on together in a multidisciplinary fashion. So a medical oncologist may be involved, a radiation oncologist may be involved, along with a urologist.
TOMASZ BEER, MD: The multidisciplinary nature of the care of this disease is really essential to the advancement in therapy. Medical oncologists, urologists and radiation therapists really need to come together to see most of these patients jointly and work together as closely as they can.
ANNOUNCER: If the cancer is localized to the prostate, treatment will focus on curative measures.
ARNOLD BULLOCK, MD: For localized prostate cancer in men generally under the age of 70, we look for some form of cure. Those treatment options would include either some form of radical prostatectomy or radiation therapy and still others around the country recommend cryoablation.
ANNOUNCER: In some high risk cases, chemotherapy will also be initiated early on.
CELESTIA S. HIGANO, MD: There is a gray zone in here where different people will use chemotherapy at different stages in the evolution of the disease. Many of us wait until there are symptoms unless it is in the context of a clinical trial, where we might be testing what we consider the traditional sort of standard chemotherapy for prostate cancer with other investigational drugs.
But I also think that the clinical trials that we have done so far do not tell us when we should start chemotherapy.
ANNOUNCER: If the cancer has spread to the bones or other parts of the body, treatment takes a different path.
CELESTIA S. HIGANO, MD: For metastatic advanced prostate cancer, usually patients are treated initially with hormonal therapy. Usually, that means lowering the testosterone level, either with surgery or with medications.
ANNOUNCER: Hormonal therapy suppresses the growth of cancer, but at some point it will fail and the cancer will start to grow again. When this happens chemotherapy is the next accepted step.
CELESTIA S. HIGANO, MD: By now, most physicians and patients are well versed in what the standard therapy is, which is the use of docetaxel, or Taxotere is the brand name. And the reason that is the standard therapy is that two large clinical trials have shown that when we use that form of chemotherapy, patients as a group live longer than if we use some other chemotherapy we've had before.
ANNOUNCER: And if symptoms like bone pain do arise, chemotherapy and radiation have proven effective in easing and relieving the symptoms.
TOMASZ BEER, MD: We know, clearly, that patients who have symptoms benefit from chemotherapy. Radiation can be used to treat pain, as well. And so, for example, if there's a patient with one spot that hurts, we might recommend a course of radiation before we start chemotherapy, because it can relieve the pain rapidly. But if there are multiple spots of pain in various areas --so if the pain is really galloping -- we move directly to chemotherapy, because if you have multiple spots and you just radiate one, you're not really solving the whole problem. But by and large, in patients who are symptomatic, we move rather quickly to initiate chemotherapy with docetaxel and try to relieve the pain.
ANNOUNCER: There is currently no cure for advanced prostate cancer, but hope is growing for many patients.
ARNOLD BULLOCK, MD: It is definitely not an immediate death sentence. Case in point, my wife's grandfather. He was diagnosed before I even knew he had prostate cancer. I was married to my wife for seven years before I knew he had prostate cancer and he was diagnosed with bone cancer. Back in the day, many African-American men were diagnosed as having bone cancer and then, on evaluating that, you find out, in fact, it was prostate cancer. And so even with metastatic bone cancer, he survived fifteen years.