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Prostate Cancer Interview with NY Urologists
Arnaldo F. Trabucco, MD & Robert Waldbaum, MD
By: Pauline Mayer, Editor
NY Hospital
& Health News
In April of 2000, Mayor
Rudoloph Guiliani had undergone a routine prostate-screening exam revealing
he had prostate cancer. His father had succumbed to prostate cancer and
now Guiliani had to decide on treatment. After collaborating
with his physicians and close family members, the mayor pulled out of the
senatorial race and entered into another race of different sorts. He
was introduced to several treatment options that included
"watchful waiting", implantation of radioactive pellets (seeds),
external beam irradiation, injections of LHRH agonist or surgery.
In a television interview with Tom Brokaw August 1, 2000
Giuliani said that he was currently undergoing hormone treatments to keep his
prostate cancer under control. He did not offer any new information as
to whether he would choose radiation therapy or surgery as a longer term
cancer approach.
Every man is faced with fear and concern when diagnosed
with prostate cancer. In most cases, the fears are somewhat dismissed once treatment
begins.
Robert Waldbaum, M.D., Director of Urology at No. Shore Hospital
Manhasset and Clinical Professor of Urology, Cornell University
Medical College
said, "according to the American Cancer Society, prostate cancer is the
second highest killer of men over the age of fifty-five. Therefore, it
is critical for a man between the ages of 50-75 to be screened at least once
a year."
Family history is important especially when more than one
male in a family has been diagnosed which means that off spring could be
placed in a high-risk category.
It has been estimated to date that 180,000 plus
men will be diagnosed with invasive prostatic cancer. That is why early
screening and intervention is critical. Starting with a simple PSA (prostate
specific antigen) blood test which can reveal a protein made by the prostate
gland in response to the presence of foreign materials such as prostate
cancer cells. It is used to detect potential problems associated with
the prostate gland.
With advances in technology and research, these numbers
can actually be reduced significantly. "Maintaining a low
fat diet, including foods rich in lycopene, combined with taking Vitamin E
and Selinimum can actually retard the onset of prostate cancer, added
Waldbaum."
Recent studies have demonstrated that African American
men have a higher incidence of prostate cancer than do men in any other group
and that their disease is usually more advanced by the time they are
diagnosed. The incidence and mortality rate for prostate cancer is
higher among African Americans than the rest of the population due to an
hormonal imbalance. Levels of the male hormone testosterone significantly
impact the progress of prostate cancer. The simplistic conclusion is that the
higher testosterone level is directly related to a higher rate of incidence
of prostate cancer and a higher rate of mortality. However, there are also
some suggestions that differences in diet between African Americans and white
Americans may also be involved.
Brachytherapy is a form of radiation treatment in which
tiny pellets containing radioactive material, such as Iodine-125, are
implanted directly into the tumor. There are several factors that must
be considered to determine if a patient is a candidate for this
treatment. The patient's overall health condition is
critical. Since this procedure is only minimally invasive, it is better
tolerated than the more aggressive surgical procedures. The age of the
patient is also important for this same reason. Therefore, an older patient
that requires treatment may consider brachytherapy as an option.
For Stage D cancer patients who opt for monthly, or every
3 months, regimen of injections of Zoladex
(goserelin acetate implant), which contains a potent synthetic decapeptide
analogue of luteinizing hormone-releasing hormone (LHRH), also known as a
gonadotropin releasing hormone (GnRH) agonist analogue is another treatment
option. Zoladex disrupts the body's testosterone production by suppressing
testicular steroid production need to watch for side effects.
In a telephone interview with Arnaldo F. Trabucco,
M.D.,* a Urologist from Rego Park
and an attending at No. Shore-Long Island Jewish Hospital at Manhasset said,
"A patient becomes a candidate for an LHRH agonist when either they have
developed clinical stage D prostate cancer or as neoadujuvenct treatments for
clinical stage C prostate cancer combined with external beam irradiation or
in patients that are undergoing or plan to undergo surgical radical
prostatectomy." Trabucco added, "It has been found that treatment
with such neo-adjuvenct treatments will reduce the glandular size of the
prostate gland and hormone sensitive prostate cancer cells prior to surgery
with the hope of reduction of positive surgical margins. The same
concept is utilized to shrink the prostate cancer prior to external beam
irradiation improving the result of the therapy. If the patient
selects external beam irradiation, this is a one-way street that the patient can
opt for, due to the fact that radiation failure prevents the patient from
undergoing a 'simple" radical prostatectomy. However, surgical
radical prostatectomy offers the patients the option of both
modalities. Whereby after removal of the prostate, if the margins are
positive, external beam irradiation can be combined to provide the patient
with the same results. The decision of utilizing surgical removal of
the prostate vs. radiation therapy is based on the patient's physiologic
status." Trabucco concluded by saying, "If the patient
has a life expectancy of over 15 years and/or is physiologically younger than 70, gold
standard treatment to date is radical prostatectomy combined with a pelvic
lymph node dissection for staging purposes. If the lymph nodes are
positive, surgery is abandoned and the patient is then referred for external
beam irradiation.
Complimentary medicine products (non
prescription/herbal) is not advisable for treating prostate cancer except
when all traditional treatment methods have failed, and only while under the
care of a physician.
In a recent report of the American Medical Association,
Urologists were more likely to
recommend surgery while radiation oncologists recommended radiation.
However, the consensus of opinion
by everyone concerned agree that some form
of treatment is recommended even if the disease is characterized as
non-aggressive. Watchful waiting is not advised.
Pauline
Mayer is President of PTM Healthcare Marketing, Inc. (New York) www.ptmhcm.com. She is former
editor of NY Hospital & Health News, (a defunct publication of the Nassau-Suffolk Hospital
Council, Islandia, NY). e-mail: ptm@ptmhcm.com for further
information.
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