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Prostate Cancer

Treating Fast Growing Prostate Cancers


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Summary & Participants

All prostate cancers are not the same. Listen as doctors describe treatment options when they believe an early-stage cancer may be particularly aggressive.

Medically Reviewed On: July 21, 2009

Webcast Transcript


ANNOUNCER: The profile of the typical man who is first diagnosed with prostate cancer is changing. That's largely due to the increasingly routine blood screening of men over fifty for a protein called PSA, often a signal of prostate disease.

JAMES A. EASTHAM, MD: So if you start checking earlier men, it's almost a self-fulfilling prophecy that you'll find these cancers at a younger age. The point is also you'll find them at an earlier, more curable stage as well.

ANNOUNCER: Another trend, of course, is longer lifespan. That means men are more likely to die from their prostate cancer, even if it grows very slowly.

JAMES A. EASTHAM, MD: Men aren't dying as young as they used to. So in some ways, they're living long enough to be bothered by their prostate cancer. And a man who's 50 has probably a 30-year life expectancy. If he's diagnosed with prostate cancer, it's unlikely that in that 30-year period of time, the cancer won't grow.

ANNOUNCER: So it may be more important than in years past to use aggressive treatments, at least in some cases. This is called "adjuvant therapy," meaning additional therapy after primary treatment with surgery or radiation, to guard against recurrence. But there are often difficult side effects, so doctors don't want to treat people unnecessarily.

DANIEL P. PETRYLAK, MD: It's important for us to select which patient is going to have very aggressive disease or which patient simply can be cured with local treatment.

ANNOUNCER: Sorting out how aggressive a particular prostate cancer is likely to be is not easy.

JAMES A. EASTHAM, MD: One of the difficulties that we have is identifying or characterizing a cancer as being slow growing or fast growing. That's one of the active areas of research, is to try to identify newer ways to characterize a cancer, because you would obviously treat a faster growing cancer perhaps aggressively or as a slower growing cancer, you might even be able to watch.

ANNOUNCER: Doctors traditionally use three factors in trying to determine how aggressive a particular cancer might prove to be.

DANIEL P. PETRYLAK, MD: Gleason score is a measure as to how aggressive a cancer is. So if we look at the cancer under the microscope, the less aggressive lesions appear to be more organized, and the most aggressive lesions almost look like spaghetti. They're very, very disorganized. So the Gleason score is a way of measuring the degree of organization and disorganization. The more disorganized the higher the Gleason score and hence the higher the chance of the cancer coming back.

ANNOUNCER: The second factor is whether or not the disease has spread to nearby lymph nodes. These glands, which are part of the immune system, are often the first place prostate cancer spreads when it has metastasized.

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