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Prostate Cancer: Latest Treatments and Emerging Therapies

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What are the complications and side effects of radiation? continued...

Other complications may include short-term bladder infections and irritation or discomfort during voiding. Men who have radiation therapy are often given a short-term course of alpha-blockers. Those are drugs commonly prescribed to treat voiding problems caused by benign enlargement of the prostate. Drugs in this category include Flomax and Hytrin.

Radiation therapy may also cause infections of the lining of the anus and intestinal infections. The incidence of these complications, though, is significantly lower with the use of conformal or IMRT techniques than with conventional external beam radiation. Some men also experience fatigue after multiple radiation sessions. The fatigue usually resolves over time.

How does active surveillance or expectant management of early-stage prostate cancer work?

It seems counterintuitive. But active surveillance or "watchful waiting" may be a good option for many older men who have early-stage, nonaggressive disease without bothersome symptoms. Active surveillance may also be a suitable option for some men with other illnesses. That's because the illness may be complicated by surgery or radiation.

With active surveillance, men with small volume, low-grade, early-stage cancers can have regular follow-up visits every six months. The visits include a digital rectal examination of the prostate and blood tests. In addition, the men receive annual prostate biopsies. This routine is an alternative to immediate radical prostatectomy.

Currently about half of all men diagnosed with prostate cancer will have low-risk disease at the time of diagnosis. This is based on several different criteria, including:

  • A prostate-specific antigen (PSA) level of less than 10
  • A Gleason (tumor aggressiveness scale) score of 6 or less on a scale of 2-10
  • Stage T1c disease, meaning that the tumor cannot be felt on digital rectal exam and is detected only on needle biopsy, or
  • Stage T2a disease, meaning minimal detectable disease in one half lobe of the prostate or less

When selecting men for active surveillance, doctors screen out men whose tumors have features that could be signs of faster-growing or more extensive disease. Then they follow the men on active surveillance very closely. If a man has any evidence of disease progression in tissue samples taken during annual biopsies, then treatment will be recommended.

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