The disturbing thing is that all of these treatments have their side effects that may not be too easy for the patient to live with. Below are outlined just a few of them to provide a reasonable mind picture:

Hormonal therapy for instance uses medications or surgery to block prostate cancer cells from getting dihydrotestosterone (DHT). DHT is a hormone that is produced in the prostate and required for the progression and metastasis of most forms of prostate cancer. The said medications are generally antiandrogens which block DHT and cause prostate cancer to stop growing and even shrink. The surgery is orchiectomy to remove the male testicles and cease the production of testosterone and DHT.

The complications of hormonal therapy include the fact that it rarely cures prostate cancer and may even cause the tumor to become resistant after one to two years. Orchiectomy is a low-risk surgery, but one that might have a profound psychological impact on the patient, while also causing hot flashes, weight gain, loss of libido, enlargement of the breasts, impotence and osteoporosis. The medications may yield similar side effects or even worse. They may also cause increased bone pain from metastatic cancer, potential liver damage with prolonged use, and possible skin rashes.

Prostatectomy is a common treatment either for early stage prostate cancer, or as salvage for failed radiation therapy. It cures the disease but because of the nerves in the prostate region that control erection, it can cause impotence. Another common serious complication of surgery is loss of urinary control, however this fades with time, at least partially. Potency pills like Viagra or Cialis can help with the impotence.

Radiation therapy treats all stages of prostate cancer with ionizing radiation, killing the cancer, but also hurting other cells in the process. The normal cells may recuperate after several weeks, but until they do, the patient may have to put up with diarrhea and mild rectal bleeding from radiation proctitis, as well as possible incontinence and impotence.

It’s just the way it is, an option between living (and) with the condition, and possibly living longer (with a slightly lowered quality of life perhaps) in the aftermath of prostate cancer treatment. It’s the patient’s call.

In 1997 the FDA approved finasteride for treating baldness. Sold this time under the trade name Propecia, it was shown to prevent hair loss due to hereditary male pattern baldness in those who take a small daily dose, although it did not work for women - even going so far as to cause birth defects.

In July 2003, Thompson, IM; Goodman PJ, et al published an article in the New England Medical Journal 349 (3) (215-24) titled “The influence of finasteride on the development of prostate cancer,” in which they discussed their latest findings concerning the drug and expressed their concerns; and on May 18, 2008, a Cancer Prevention Research that was published online laid it all to rest, stating specifically that “Finasteride Does Not Increase the Risk of High-Grade Prostate Cancer.” This online publication was in fact titled likewise and designated as ‘a bias-adjusted modeling approach.’

Finasteride has been known for a while as one of two medications that block the conversion of testosterone to dihydrotestosterone (DHT), a hormone that fuels prostate cancer growth and progression - the other being dutasteride. By this process, prostate cancer tumors generally cease to grow and often start to shrink.

These two medications have also been explored for their potential to prevent the occurrence of the disease - and with some degree of success too - except that while finasteride appears effective against the development of lower-grade prostate tumors, it seems to lead to a greater chance of higher grade cancers occurring in the patient.

This negation of an overall survival improvement suggested that finasteride might in fact not be a blessing at all. However, as depicted earlier on, more recent research - an update published in 2008 clearly showed that finasteride did not increase the percentage of higher grade cancers. If anything “finasteride reduces the incidence of prostate cancer by 30%.” As a matter of fact, finasteride may even decrease the overall PSA levels by as much 50% or more!

The most common side effects of finasteride are decreased libido, ejaculation disorders, and impotence.

Radiation therapy makes use of ionizing radiation in the bid to kill prostate cancer cells. The radiation is absorbed in tissue and damages the DNA in cancer cells, encouraging apoptosis. It damages normal cells in the body too, but while they are able to repair the radiation damage, the cancer cells cannot. Hence radiation kills prostate cancer cells while hurting normal cells in the body only enough for them to repair themselves.

One form of radiation therapy, external beam radiation therapy (EBRT), applies radiation from a linear accelerator source to attack the cancer. It is often difficult to specifically target the regions where there are cancerous tumors in this way, but improved technology makes it possible.

Intensity modulated radiation therapy (IMRT) is a technological advancement that allows for higher doses of radiation to be administered to the prostate and seminal vesicles with less damage to the bladder and rectum exploits. It helps to adjust the radiation beam to conform to the shape of the tumor. Because of IMRT, there are fewer side effects to radiation treatment for prostate cancer.

Prostate brachytherapy (or simply brachytherapy) may be reasonably called internal radiation therapy. It is an ideal prostate cancer treatment for men who have low to intermediate treatment risk features, and so it can even be performed on an outpatient basis. Also referred to as permanent implant brachytherapy, the procedure involves several tiny “seeds” that contain some kind of radioactive material being placed surgically inside the prostate. The seeds give off short-distance, lower-energy x-rays that eventually become inert after killing the cancers.

Naturally, the damage to other cells in the region persists until the effects of the radiation wear off, but even then, brachytherapy is still associated with excellent 10-year outcomes and relatively low morbidity. In addition, the risk of exposure to others is considered to be relatively insignificant. The side effects generally come about a few weeks into treatment - diarrhea and mild rectal bleeding (radiation proctitis), and urinary incontinence and impotence (potentially). The good thing about prostate cancer radiation treatments is that these symptoms tend to improve over time.

Cryosurgery or cryotherapy is what can be called a surgical procedure in which cancerous cells in the body are frozen to such extremely low temperatures that they simply just- freeze up and die. In the treatment of prostate cancer, two metallic rods are inserted into the prostate gland through tiny surgical incisions in the perineum and guided by ultrasound imaging - the ultrasound part was perfected by one Dr. Gary Onik.

The freezing of the prostate is done by conducting low temperature through the metallic rods from highly purified argon gas to the organ, pushing the temperature as low as - 302oF, guaranteeing that the fluid (water) in the cells will freeze. The entire prostate gland is destroyed in the process, but the cancer dies. Perhaps the best thing about this treatment for prostate cancer is that it generally causes fewer problems with urinary control than other treatments.

As a matter of fact, when it is used as the initial treatment for prostate cancer, and when it is performed by an experienced surgeon it offer a better ten year guarantee of biochemical disease free living than other treatments - radical prostatectomy and radiation therapy included.

Further to the above, cryosurgery can be completed in much shorter time than prostatectomy can, and will littler loss of blood to the patient. In addition, the prostatic adenocarcinoma remedy has also been demonstrated to be superior to radical prostatectomy for any form of tumor that happens to recur following radiation therapy. Even after the treatment, bladder control returns very rapidly, and the patient can stop wearing a catheter around his ankle within only a few days.

But there is one not very pleasant catch - impotence occurs in cryosurgery up to a dismal ninety percent of the time. No one likes it, but it turns out that way; so they are looking for better ways to make it- better- Cryosurgery, is in use in many parts of the United States although there are those who would rather put it down as a procedure that is still in trials for perfection.

This way these androgen treatments cause the tumor to stop growing and even shrink. Although they rarely cure the disease (since the cancers generally become resistant after a while), they are a good way to slow the disease down, especially when it is metastasizing.

Prostate cancer hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy because of this. The androgens, produced mainly in the testicles, stimulate prostate cancer cells to grow; and as stated in the previous chapter, lowering their levels in the patient often causes the cancer shrink or grow more slowly.

The side effects prostate cancer androgen hormone therapy are pretty much the same as those that are experienced if the patient had to undergo an orchiectomy (surgical removal of the testicles to hinder testosterone production). There isn’t as much of the psychological impact of surgery, but the hot flashes are there just the same. It is common for such a patient to begin to experience weight gain and loss of libido within a year or more of the treatment, while in some people it doesn’t even take that long.

One of the most common side effects of androgen deprivation therapy is the enlargement of the breasts (gynecomastia), a source of considerable embarrassment to most men. Also, perhaps the most devastating complication, impotence can make a man desire not to want to continue living; and osteoporosis, a bone condition characterized by a decrease in density, which also results in the bones being porous and more easily fractured than normal bones.

GnRH (gonadotropine releasing hormone) agonists may also cause increased bone pain from metastatic cancer, and certain estrogens may even increase the risk for cardiovascular disease and blood clots. Ketoconazole specifically has been known to bear with it a certain risk of liver damage to the patient, especially with prolonged use; and another drug, aminoglutethimide, has been known to cause skin rashes. For this reason, the doctor has to be fully apprised of the patient’s medical history before administering such treatments.

Hormonal therapy for prostrate cancer aims at blocking prostate cancer cells from getting dihydrotestosterone (DHT) for their growth and progression. This is done either with the aid of medications or by surgery (orchiectomy).

DHT is a hormone that is produced in the prostate and required for the growth and spread of most forms of prostate cancer. By blocking DHT, prostate cancer generally stops growing and may even shrink. But the reason why hormonal therapy is usually reserved for late stage disease when it is hardly curable at all is because it rarely cures the adenocarcinoma in the first place. In fact, malignant cells that initially respond to hormonal therapy characteristically become resistant to the therapy after just a couple of years, sometimes not even lasting so long.

As stated earlier, hormone treatments aim for the pathways the body uses to produce DHT, which is a feedback loop that involves the testicles, the hypothalamus, and the pituitary, adrenal, and prostate glands. The hormones involved in this process are several as well, namely the gonadotropin releasing hormone (GnRH), the luteinizing hormone (LH), testosterone, dehydroepiandrosterone (DHEA), and DHT, all generally from different sources in the body. Very simply hormonal therapy decreases levels of DHT by interrupting the loop at any point.

An orchiectomy is a surgical castration to remove the ability of the body to produce testosterone. Although there are other sources of the hormone, there isn’t enough to produce DHT or transform into it. Antiandrogens work in a different manner, using medications like flutamide, bicalutamide, nilutamide, and cyproterone acetate to directly block the actions of testosterone and DHT within prostate cancer cells. Other medications block the production of adrenal androgens like DHEA, only applicable in combination with other methods to achieve total androgen blockage (TAB). These drugs are ketoconazole and aminoglutethimide.

Finally GnRH agonists and antagonists help to interrupt GnRH action. The agonists (e.g., leuprolide, goserelin, triptorelin, and buserelin) suppress LH by downregulation after an initial increase in its production, but the production crashes sooner than later; the GnRH antagonists (e.g., abarelix) however suppress the production of LH directly.

One important factor to consider in case of a cancer of the prostate diagnosis is what stage the cancer is at. A disease in the early stages can still be cured, but advanced stage prostate cancer cannot. When looking to cure prostate cancer treatments, such as radiation therapy, prostatectomy, proton therapy, cryosurgery, and high intensity focused ultrasound are readily available. Late stage disease however requires treatments that will slow the progression of the disease and relieve the symptoms while also prolonging the life of the patient. To that end, hormonal therapy, chemotherapy, and perhaps some radiation treatment might be the best options.

However, all treatments for prostate cancer have their own side effects, which in their own way may be devastating for the patient. As a result, it may be necessary to decide if or not to undergo therapy at all in the first place. It is possible, because prostate type of cancer does not ordinarily progress too rapidly, for the patient to age and die of other causes before the first symptoms of this disease appear, which would then mean that treatment is unnecessary. For such a patient, watchful waiting might be the best call, as opposed to needlessly putting the man through the side effects of prostate cancerous tumor treatment.

An old man diagnosed with prostate cancer may desire to live longer, while another may desire to let it all go. As such, the age, state of mind, and the desires of the patient may also go into the consideration process when deciding on therapies. Some patients may prefer treatments that do not affect their sexual function too terribly as opposed to procedures that may leave them impotent, and others may have serious and life threatening (adverse) reactions to certain therapies. These factors also have to be thrown into the mix for proper effect.

Finally, there is the question of the physician’s understanding of the case, and the treatments that are within reach (available at that clinic or not too far away) at the time. A clever and intuitive oncologist or urologist may be able to observe certain things about the patient that are not immediately apparent, which they will try to pass across to him. If the patient is paying attention, he will listen and consider those new facts as well. Ultimately, it may be wiser to allow the doctor to make the call based on all the information that has been provided? but then all the necessary information should be provided.

Radiation therapy is most certainly also an option, an alternative to surgery in several cases when the patient is at risk of complications from prostatectomy, or if the man has reservations about surgeries that he is not interested in overlooking. Radiation therapy, often called radiotherapy is an effective way to intervene with prostate cancer by using x- or gamma rays in ionizing (high energy) radiation to kill the cells of the prostate sarcoma and stop them from growing. It can be done either from the outside (by external radiation therapy from a linear accelerator) or from the inside (internal radiotherapy or brachytherapy, using radioactive “seed” implants) of the prostate gland.

Radiation therapy is most effective for early stage prostate cancer and actually has the potential to cure the disease if appropriately applied at that time, especially if combined with some form of prostatectomy when the mutated cells have not had the chance to spread from the prostate. The disease is a bit more resistant and treatment more problematic once the malignancy metastasizes, but even then radiotherapy remains one of the most relied upon treatments for this condition .

But what happens when you experience returning prostate cancer after radiation treatment?

Very simply, the doctors have to rack their brains for another way to remedy the situation. All of a sudden they will be looking at various other ways of curing you that they might not have considered in the first instance, perhaps due to personal (on your part) or professional reservations (on their part). A radical prostatectomy is often a final word in prostate cancer treatment, but it often can have problems, especially when dealing with metastatic prostate malignant cancer that has had the chance to spread to other parts of the body. In that wise, they might require other procedures to compliment the prostate surgery, or even to make it possible.

Chemotherapy may cause severe side effects, but they are side effects that most patients of prostate cancer will gladly live with when faced with the alternative. Hormonal treatments and immunotherapy largely employ similar principles by administering chemotherapeutic drugs to the patient and allowing the pills to directly kill the malignant cells, starve the sarcomas to stop them from continuing to spread, and empower your immune system to battle them itself.

RADIOTHERAPY – otherwise known as radiation therapy, this is a procedure that is generally considered as an alternative to prostatectomy in most cases, on that uses x-rays and high-energy radiation to kill cancer cells or stop them from growing. In actual fact, radiotherapy treats all stages of the melanoma because, once absorbed into the tissues, the ionizing radiation damages the DNA in the cells and causes them to die in a process called cell apoptosis.

Although it affects healthy cells as well, causing some notable side effects, radiation therapy is often not sufficient to cause the normal cells permanent damage. Whereas the cancer cells die off, the normal cells recover and are able to regenerate, at which point the side effects of radiation (radiation prostitis) fade into oblivion.

One form of radiotherapy, external radiation therapy, beams radiation from a machine known as the linear accelerator onto the body. Using intensity modulated radiation therapy, or IMRT, the high energy rays can be adjusted and conformed to the shape and size of the tumor, allowing higher doses into the prostate and seminal vesicles with less damage to the bladder and rectum.

A second form of radiotherapy treatment for prostate cancer, internal radiation therapy (also known as brachytherapy), employs radioactive material sealed in tiny “seeds” for insertion into the prostate under the action of local anesthesia. It is preferred in certain instances to the previous means because it is gentler on healthy tissues in the vicinity, and it appears to be no less effective than surgery.

Howbeit, brachytherapy appears to work best only for men with early-stage prostate kind of cancer. If the cancers have start migrating from the prostate, it may still be combined with external beam therapy, but aggressive metastatic disease is considered well beyond the scope of radioactive seed implants in the prostate. In any case, the seeds become inert after a while at no risk to the patient, and there are often good ten-year outcomes with relatively low morbidity.

HORMONAL THERAPY – there are cases in which hormones are used to treat prostate cancer, especially because the carcinoma is considered to be hugely hormone dependent for its growth, and also especially if the patient is unable to undergo surgery or radiation because of other health problems that he might have. Used on early stage prostate carcinomas, this kind of treatment may not actually cure the disease but it can cede the growth of the tumor.

In addition, hormonal therapy tends to cause cancerous cells to shrink so that other treatments may be applied to them, such as radiation or surgery. Through hormone treatment, body levels of male hormones, especially testosterone, which fuels the growth of cancers, can be reduced. It can make use of medications to block the prostate tumor cells from reaching the critical quantities of hormones needed for their growth and propagation by relinquishing their production; or the procedure may employ surgery to remove the glands that produce the hormones in the first place.

The most successful hormonal treatments are orchiectomy and GnRH agonists. Orchiectomy, although a surgery, removes the testicles that produce the masculine hormone testosterone, which also contributes to the production of dihydroepiandrosterone, a major contributory factor in prostate cancer progression. Gonadotropin-releasing hormone (GnRH) agonists are drugs that block spermatogenesis in men, and although they are more expensive, they are preferred for cosmetic and emotional reasons.

Hormone treatments are limited because they don’t cure the cancer. In fact, the malignancy may become adapted to them sooner than later, mutate further, and resume their growth, usually within a two year period.

Cryosurgery for prostate cancer is one such cure; referred to by most cancer specialists in the medical community today as cryotherapy, this treatment for cancer type of prostate emerged in the early 90s. It actually effectively eradicates cancer of the prostate by freezing the prostate gland itself and causing the cells in it to die off. Anesthesia may be used, but it is not often general anesthesia; and then the doctor inserts needles into the gland through the perineum, and uses the needles to produce very cold temperatures. The needles are inserted by the aid of ultrasound technology (perfected by Dr. Gary Onik), and the cooling is done with the aid of highly purified argon gas. The freezing destroys the entire prostate when the water in the cells crystallizes into ice; any cancerous tissue within the prostate also dies of in this way.

Because they can precisely control the size and shape of the ice balls and monitor the freezing, prostate condition is very effective and reduces the risk of blood loss during the entire procedure. Prostate cancer patients who want to avoid major surgeries or those who think that “watchful waiting” is not ideal, are those for whom the procedure is best. In addition, the technique is also very good for those who have failed a previous radiation treatment for their adenocarcinoma.

Cryosurgery is effective in both safety and durable efficacy parameters when treating prostate malignant cancer. The procedure yields mild morbidity in comparison with other treatments; it can be repeated, and it may also work well as secondary treatment when other primary interventions aren’t working.

There are risks to the procedures though, the first being sexual function impairment, as impotence occurs up to ninety percent of the time. However, recovery time after the procedure is greatly reduced; in many instances, the patient may be asked to stay in the hospital for overnight observation, but it may also be an outpatient operation. The procedure often takes less than two hours and there is minimal pain while it is done. Why, patients have been known to return to work within a few days.

So what is keeping them? They are still working on that one final problem, looking for ways to reduce the impotence rate at least.