Prostate Cancer Variables

Prostate cancer is a highly prevalent malignancy but, come to think of it, most medical oncologists I know have but a handful of cases. In my own clinic, prostate cancers are outnumbered by even the sarcomas & gliomas. Since the role of the medical oncologist is most active in stage IV of this disease, does this mean that majority of patients are diagnosed early & subsequently cured? Are even very advanced cases managed by another specialty? Are full options offered at all?

Since I don't work with a specialized urologic tumor group, the cases I see have already failed previous cancer treatment &/or are in a very advanced stage for which chemotherapy is contemplated. There are points in a case history that medical oncologists look into upon first evaluation to "know" an individual tumor. Many times in the course of such a review, the advantages of the tumor group concept is highlighted. Telling details may be found in the answers to the following:

First Presentation:

Risk category (eg. Partin tables, MSKCC nomograms) includes tumor extent, PSA, Gleason scores…
Choice & appropriateness of initial therapies
Type & extent of surgery, if applicable.
Brachytherapy details, if applicable. Ports too, if external beam irradiation.
Initial & subsequent hormonal manipulations

Treatment Failure/Relapse/Recurrence:

Duration of initial response, if any
Management of apparent "PSA failure"
Staging procedures
General health & other medical problems
Patient's wishes

What is this gibberish?! Well, if you're a patient, make it your business to find out. Ask, even if you must get another opinion from a specialty team. Prepare for the talk by checking out the NCCN guidelines.

Previous Comments

Hi, My Dad is being treated for Prostrate Cancer. He has been given Luprolex 3X (Apr 2008 to Dec 2008 - given every 3 months) He wants to know when it will stop? His PSA started 3000+, then 5.6, then 1.5 level. His health his improved. Pls advice. thank you.

Posted by Leonard Dy at January 2, 2009, 12:57 pm

In the old days, they just removed the testicles. That was permanent– and much cheaper. If he’s responding to hormonal manipulation alone (am assuming stage IV), I’m afraid that the end to leuprolide is not in sight. Or so one hopes. Docetaxel is the chemotherapy drug indicated when stage IV disease no longer responds to hormonal agents. Its so much tougher to take.
Posted by oncodoc at August 15, 2009, 2:46 pm

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Head and Neck Cancer: The Organ Preservation Option

Concomitant irradiation & chemotherapy can help preserve the normal anatomic outline in locally advanced head and neck cancer without sacrificing treatment efficacy. 

It seems that the latest outcomes of combined chemoradiation are comparable to those of radical surgery with further postoperative treatment.

True, chemoradiation requires focused expertise and is technology-dependent.  As such, this option is found only in the larger Centers. True, the addition of terrific induction chemo may further improve organ preservation rates or, if preliminary trial results hold up, even survival. 

Yes, well & good... but will function be preserved as well as anatomy?  And… can Filipinos afford these cancer treatments?   These are matters up for discussion, but not just amongst medical professionals.

Its obvious that doctors should get their acts together to organize Head and Neck cancer services at their institutions. The name of that game is multidisciplinary coordination, wherein radiotherapists, medical oncologists, subspecialty surgeons, and supportive services work to provide full options to the community.  It would be a shame if a life-saving opportunity is lost by improperly timed interventions.  The final decision is the patient's after all, and acceptance or rejection of risks, side effects, and costs is an exercise of their personal choice. 

Evidence-based information from all participating specialties is invaluable in this regard.  All patients deserve a multispecialty plan of action.

New Drugs for Kidney Cancer

This year, the star of the Atlanta show was kidney cancer, specifically, advanced renal cell carcinoma. For the longest time, I looked more to heaven than science to guide me in the treatment of this disease, being limited to drugs which, in many cases, made patients feel worse than the cancer. When those didn't work or ceased to work, one was exposed as clueless. Nobody likes a recipe book approach. Doctors are supposed to know & understand their enemy, but renal cell cancer was shrouded in mystery.

Molecular science is doing much to remove that shroud.  For me, the first hint of a better deal came in the effort to medically control the blood supply of tumors, for kidney cancer is just such a vascular bloody mess. Then came targeted therapy– the drugs that specifically interfered with cell signals to impact upon cell nutrition, reproduction, and death.  I can hardly keep up with the flood of new knowledge nowadays, or the variety of drugs shown to be active in this disease: the nibs (sunitinib, sorafenib), mTOR inhibitors, bevacizumab. One now dares to anticipate combinations in the immediate future.

When the leadership of a country with vast resources declares a "War on Cancer" as national policy, you can't help but hope that others will do likewise for the benefit of all. Attaboy!– its pay-off time.

Toons by Buck Cash.