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What is the most effective treatment for prostate cancer?

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Oncologist, Surgical
Practicing since : 2004
Answered : 59 Questions
I have been diagnosed with postate cancer. My question is I am aware of various methods of treatment. I am looking at what would be the most effective and with the least amount of side affects. My gleason score is a 6? Do you hav any suggestions? I live in central valley of California. XXXX
Posted Sun, 9 Feb 2014 in Cancer
Answered by Dr. Krishna Kiran Kannepalli 2 hours later
Brief Answer: Need more information Detailed Answer: Hi. Thanks for the query. Before I can suggest anything more information is required. How was your prostate cancer diagnosed. Did you undergo a screening test or were you symptomatic. What is the PSA level. Were adequate biopsies taken from both lobes of the prostate. Did you undergo any imaging test. The best is an MRI of the pelvis. Did you undergo any blood tests(most important of which is an Alkaline phosphatase estimation). What treatment did you receive for your bladder cancer in addition to surgery. When was the last check cystoscopy performed. What was the histology of the bladder tumor. Please write back to me with the above details. I will be happy to answer you back.
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Follow-up: What is the most effective treatment for prostate cancer? 11 hours later
In the past 3 to 4 years my PSA has gone from < 1 to around 3, sometimes a little over and other times a little under. 2 1/2 years ago I had a biopsy ( 12 probes ) and it showed a couple of suspicious areas, but no cancer detected. A month ago I had another biopsy ( 12 probes ) and in the suspicious area last time, cancer was now found. Sent biopsy to XXXXXXX XXXXXXX to confirm and suspicious area now contains cancer with another area close by that is suspicious. The XXXXXXX Score was 3 + 3 = 6. The only imaging was with a sonogram when I had the biopsy and the prostate was not really enlarged. I believe it was measured at 22. To my knowledge no other blood tests. The bladder tumor was found at a very early stage and was removed. I was initially on a 3 month check up, the 6 month, yearly, and now every 2 years I go back to get my bladder checked. No history of bladder cancer in my family, but there is a history of colon cancer. I am considering four different approaches. Three which would be radiation and the forth that is surgery. If surgery I would look at the robotic. The radiation I would consider either cyberknife, regular radiation ( 8 wks. ), or Proton. My question to you would be I presume all four are equally effective? If that is the case then which one would have the least amount of side affects, both short term and long term? Talking to various doctors and looking on the internet there seems to be a vast array of opinions on this subject. For the lay person like myself it is very confusing when it comes to making the correct choice? I would really appreciate any real valid advice you could give me. Thank you, XXXX
Answered by Dr. Krishna Kiran Kannepalli 3 days later
Brief Answer: In your case, radiation is preferable. Detailed Answer: Hi. Thanks for providing the details. Let me summarize your case. You are asymptomatic at present. You lead a healthy and active lifestyle. Your PSA levels are not greatly elevated and the Gleason's score indicates that you have a low grade cancer. At 68 years, you have a good life expectancy. The natural course of your cancer is going to be indolent and therefore, in your case treatment should not do more harm than the disease itself. As per NCCN guidelines, you come under the very low risk category of prostate cancer (with the available information, because the number of positive cores and the disease burden in each core are not mentioned). Active surveillance, Radiation therapy or surgery(radical prostatecomy) are all options and decision making is not at all easy. The only treatment which can result in "cure" is surgery. The other options including radiation therapy are done assuming to cure the disease as there is no 100% sure shot way of knowing whether the disease has been eradicated or not. Having said that, surgery of the prostate is not an easy task. Radical prostaectomy is associated with complications, especially urinary incontinence. The best approach now-a-days is a robotic radical prostacectomy and is available in a few centers in your country. Radiation is also an equally good option. In your case IMRT is preferable to cyber-knife. Another option is to do nothing and to undergo PSA testing along with clinical examination every 6 months. This is however not an option for the anxious patient. In my opinion, considering the pros and cons, radiation would be a good choice for you. Surgery is also a good option ( I would prefer Radiation) provided it is done by an experienced robotic surgeon. Hormonal treatment (androgen deprivation therapy) is not indicated for you as you have early prostate cancer. I hope I have answered your query. Please feel free to write back in case you have any other queries.
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Follow-up: What is the most effective treatment for prostate cancer? 1 hour later
Dr. XXXXXXX XXXXXXX Kannepalli, I do really appreciate your response and the information that you provided. I do have one more question. I would really like some valid data on Cyperknife procedure for someone like myself. I have a GP doctor that is encouraging me to use that procedure, because of the time and simplicity involved. Is there current independent studies that compare Cyberknife vs. IMRT? I have already decided that my preference is to use radiation. I am just torn between choosing IMRT or Cybernife, with an outside chance of Proton? From what I understand all are about equally effective in cure rate, it is just side effects that I am really wondering about. I happen to be very active in business and outside activities and hope to continue to be for many years. My hope is not to have the side effects interrupt my life style. I will wait for a response and Thank you, XXXX
Answered by Dr. Krishna Kiran Kannepalli 3 days later
Brief Answer: Brief answer: Please read the article below Detailed Answer: Detailed answer: Hello, Please read the study for your reference at the below link: WWW.WWWW.WW The choice is yours ultimately. I am sure you would be able to take the right decision here. Keep the hopes alive and wish you good health. Regards,
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