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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