Prostate Cancer Management

“Management" is increasingly the way to think about dealing with prostate cancer. The idea that cut (surgery), burn (radiation) and poison (chemo) methods "cure" is less true than many victims think. All guys treated these ways will be monitoring their condition for the rest of their lives. Why? Because there is always the real chance that a recurrence will take place to say nothing about whether these three treatments were as successful as hoped. Recurrences can be treated by management methods, and furthermore, the original diagnosis can be handled in the same way. I know because I've been doing exactly that for nine years.
The methods used are some form of hormone inhibition, the basis being that prostate cancer - different than most cancers - is hormone mediated. Hit the hormone right, and the tumor is zapped. The earliest method was to inhibit testosterone directly. The technique being used is subdermal injections that last for months, currently three to four months, after which the implant has to be renewed. After getting the testosterone really zeroed, the inhibition is stopped, and the PSA value watched at regular - perhaps four-month - intervals. As the value rises, the treatment is re-initiated, after numerous months, perhaps a year or two. Hence the terminology is "intermittent hormone Inhibition.” More recently, overwhelming testosterone with estrogen is being used. I'm on that now, and I prefer this advance.
Now I'm not suggesting that there are no side effects. Once, a guy is diagnosed with prostate cancer, he is going to live with some form of such effects no matter what method is used. The cut and burn methods all too often, for example, leave permanent scar-tissue build up and some degree of impaired bladder control, colon irritation, or sex dysfunction. Zapping testosterone has such effects too, so it isn't the perfect choice, though it has the advantage that its side effects are temporary - not permanent as is often the case with the other methods. 
Hormone inhibition can become ineffective is some cases after a while, and so other methods of treating hormone-refractory prostate cancer is another stage of the management art. The perfect choice is still in development, and its arrival time on the clinical treatment scene is uncertain - hopefully only a couple years. A prostate-cancer vaccine that would hit cancer cells - whether in the prostate or metastatically located elsewhere - is the promised idealized method. Such vaccines may need to be genetically tailored to each victim's genome, an increasingly understood concept for most all drug therapies - cancer and others.
The basic problem that any newly diagnosed guy faces is which way to go. For most, the "choice" is made with little or none of his participation. That is, the physician who makes the definitive diagnosis - doing such things as a biopsy of the prostate and assigning a Gleason Score - is very likely committed to one of the methods of treatment. A surgeon diagnosed me, and I told him I did not want surgery at that time and wanted another opinion. Nine years ago that was a difficult decision - not so now. Progress has been made in alternative treatments. The patient needs to get second opinions and look into choices that are appropriate to his particular case.
The progress of prostate cancer, if diagnosed early, is usually slow enough for such considerations even if they take weeks.
Clearly a viable alternative exists to cut, burn, and poison, and the side effects from intermittent hormone inhibition are milder and more reversible compared to those sometimes encountered from other methods.
Evans Roth June 28, 2006