Prostate cancer: New studies of combination therapy

Doctors have finally begun to understand prostate cancer. Geneticists have identified abnormal genes that increase a man's vulnerability to the disease. Epidemiologists have discovered that a diet high in saturated fat is linked to an increased risk, while tomatoes, whole grains, fish, soy, and the mineral selenium appear to be protective. Urologists are learning how to use the PSA test to detect the disease. Radiologists are developing new ways to obtain images of the elusive gland, and oncologists have honed their understanding of what makes prostate cancers grow and what slows the multiplication of malignant cells.

It's important progress that has resulted from teamwork. Every man stands to benefit from these new insights, but men with prostate cancer have an additional urgent need. Fortunately, there have been important gains here, too. In fact, each of the standard therapeutic options has registered major improvements:

  • Surgical removal of the gland, the radicalprostatectomy, has become safer and requires a shorter hospital stay. In addition, the nerve-sparing operation can help preserve potency, and laparoscopic surgery can reduce postoperative pain, at least for some men.

  • Radiation treatment has improved in two ways. Three-dimensionalconformaltherapy has made externalbeamradiation better than ever, allowing radiation oncologists to deliver more cancer-killing x-ray energy with fewer side effects. In addition, brachytherapy, a newer approach, allows doctors to place radioactive seeds directly into the gland, eliminating the need for daily trips to the hospital.

  • Hormonal treatment has benefited from new drugs that can dramatically lower levels of testosterone, the male hormone that fuels the growth of prostate cells.

Watchful waiting — close observation without active therapy — has also been refined. Doctors have learned that this option is best suited to older men with less aggressive tumors, and they have improved their ability to follow the disease and initiate therapy if it becomes necessary.

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