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Federal Consumer Information Center Understanding Treatment Choices Federal Consumer Information Center: Understanding Treatment Choices for Prostate Cancer
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Pain Management

Over time, metastatic prostate cancer often stops responding to hormonal therapy. Advancing disease may be accompanied by painful symptoms, usually involving the urinary tract or bones, along with weakness, fatigue, and weight loss.

Doctors, including specialists in pain control, can offer a variety of ways to counteract such symptoms and help the patient achieve comfort. Radiation, with either external beam, radiation therapy of periodic injections of bone-seeking radioactive chemicals (radionuclides), may ease pain caused by bone metastases, and it may also delay the progress of disease. Surgery call be helpful in opening a blocked urinary tract. Beneficial drugs include steroids and other "second-line" hormone therapies as well as painkillers. When pain cannot be entirely eliminated, it can be effectively relieved in the majority of patients.

The Decision Is Yours

An important consideration to factor into your treatment decisions is that success is not guaranteed. As many as half of the apparently localized cancers turn out, at sugery to have already spread. And up to one-fourth, despite apparently successful surgery, will produce a recurrence over the nest several years. Thus, while aggressive treatment will be unnecessary for some men, it will prove inadequate for others.

In coming to a decision, you may find it helpful to thoroughly discuss your treatment options, including benefits and side effects, with your wife/partner. You may also consider contacting your local prostate cancer support group after consulting with your primary care physician and one or more specialists. Getting second opinions and different perspectives call be very helpful.

Your decision does not need to be rushed. Take time to explore all your options. You may prefer a teaching hospital or a cancer center for treatment, choosing a surgeon or radiation oncologist who has extensive experience in the newest, least traumatizing techniques. You may want to take part in a clinical trial evaluating new approaches. You will also want to keep abreast of new developments checking with sources such as NCI's Cancer Information Service (I-800-4-CANCER). Ultimately, the decision tests with each individual. Each man has his own priorities and knows best which choices feel most comfortable for him.

New Directions

Prostate cancer research is advancing on dozens of fronts. Scientists are probing the basic causes of disease, developing markers to distinguish slow-growing cancers from aggressive cancers, and testing drugs to control or reduce risk for prostate cancer. Most of the results are preliminary at present.

Genes and prostate cancer. Researchers are exploring numerous links between genes and the development of prostate cancer. They have identified several genes that may affect a prostate cancer's ability to spread (metastasize), a gene change spurred by hormonal therapy, and a gene flaw that interferes with the body's defenses against environmental carcinogens. The presence of multiple identical genetic segments (DNA repeats), which appear to intensify signals that order the cell to multiply, may provide a better way to predict a cancer's aggressiveness.

Control. Researchers are investigating the possibility that drugs might keep latent prostate cancers from developing into active cancers. In NCI's Prostate Cancer Prevention Trial (PCPT), 18,000 healthy men age 55 and older are taking either finasteride (currently used to shrink the prostate in benign prostatic hyperplasia) or a placebo every day for 7 to 10 years. Smaller trials are testing DFMO, a drug that inactivates an enzyme that cells need in order to multiply, and 4-HPR, a vitamin A analog that may block hormone-responsive tumors.

Reduce risk. Since prostate cancer is less common in populations with low-fat, high-fiber, high-soy diets, scientists are also looking into the possibility of using diet to prevent prostate cancer from developing. There is still no evidence to show that switching to a healthy diet after years of eating high-fat foods will make a difference, but small studies are testing the effects of a low-fat, high-soy diet among men who have an increased risk of prostate cancer and men who have already been treated for prostate cancer. There is some evidence of a lower incidence of prostate cancer in men who eat lots of tomato-based foods, especially tomato sauce cooked with a little olive oil.

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