Treatment Methods for Early and Advanced Prostate Cancer PDF

Preface

Prostate cancer is the most enigmatic of the common solid malignancies. Second only to lung cancer as a killer of men beyond middle age, it warrants more attention than it currently receives from governments, researchers and the general public worldwide. One major reason for this continuing neglect is the observation that the majority of men as they age harbour small foci of adenocarcinoma within their prostate that never become clinically significant. As a consequence, worries about over-diagnosis and over-treatment have surfaced and turned many doctors away from the task of identifying and treating earlier the more aggressive lesions that result in such significant morbidity and mortality. In fact, the time has come to abandon the prevalent attitude of nihilism about prostate cancer because, potentially, much suffering could be avoided and many lives saved.

Treatment for prostate cancer itself is evolving rapidly. For smaller 'low risk' tumors, active surveillance with selective delayed intervention is becoming increasingly popular; however, worries persist about the degree of accuracy with which we can detect local or distant progression. The Holy Grail for the management of localized prostate cancer is to eradicate the cancer effectively, while minimizing the collateral damage to adjacent structures such as the neurovascular bundles.

New technologies such as the da Vinci robot to facilitate laparoscopic radical prostatectomy and low dose brachytherapy both offer this prospect, and are rapidly becoming the dominant active treatment options in North America. By contrast, locally advanced prostate cancers are probably best managed by conformal external beam radiotherapy (EBRT) with pre- and sometimes posttreatment hormonal ablation, although high dose (HD) brachytherapy is looking very interesting.

Once prostate cancer has spread to either lymph nodes or bones, hormonal therapy is usually the first line of treatment and may be effective for many months or years. Eventually, however, hormone relapse develops and second line treatments need to be considered. Chemotherapy with taxotere has now been shown to improve survival and several newer therapies including endothelin A antagonists look promising in this context.

In this volume we have tried to cover all these rapidly evolving areas in a concise, informative and evidenced-based fashion. More and more patients and their families lives are touched by prostate cancer; we sincerely hope that this book will help those who care for them do their job with better, more readily accessible information.