Preface | Detection | Diagnosis | Evaluation | Treatment

	TREATMENT: The most controversial aspects involving prostate cancer are the recommended methods of treatment which may be greatly influenced by the vested interests of the physician, the extent of their knowledge and experience with the treatments of the disease and their adherence to their hypocratic oath. The possession of an MD License or the title of Urologist does not insure that the physician is qualified to treat prostate cancer. Early detection is of paramount importance in the success of treatment of this number two cancer killer of men, which is rapidly approaching number one status. The notion that we can hold off treatment until symptoms appear is foolhardy and increases the likelihood that the patient's lifespan could be severely reduced, or his life be terminated in short order. Lack of adhering to the proper administration of treatment modalities can only be considered as malpractice and a violation of the patients constitutional rights and could contribute to the patients early demise. 1. Combination Hormonal Blockade: is the first and mandatory treatment regardless of the initial stage of the disease. Combination therapy by definition is the use of TWO, (2) medications, not 1. Both an LHRH Agonist, Lupron or Zoladex and an Antiandrogen, Flutamide, Casodex, Nizoral, Nilutamide or Cytadren with HC) - sequentially before a patient can be determined to be hormonally refractory. Patients with organ confined disease, confirmed by reevaluation may opt for secondary therapy such as Cryo, and RP if they are willing to accept the morbidity of a Radical Prostatectomy. No patient with metastatic disease qualifies for ANY form of local therapy. 2. Cryo prostatectomy: Option for secondary therapy for those who qualify. (Disease confined to the prostate gland.) 3. Brachy Seed Implantation: Option for those who qualify as above, and are willing to accept the potential morbidity. 4. Chemo Therapy: Mandatory for those who become Hormonally Refractory. Recom-mended medication: start with Velban and Emcyt. 5. Radical Prostatectomy: Only for those who have organ confined disease and are willing to accept the extreme morbidity, side effects created, the lengthy hospital confinement and exorbitant cost. 6. External Beam Radiation: Another morbid procedure that can damage or destroy normal tissue and create residual effects that can impede normal body functions until death. 7. Watchful Waiting: This attitude is promoted on the assumption that the patient's disease will remain dormant for an extended period of time. When there is evidence of the presence of the disease, if the patient agrees to accept the risks that he will be one of a small minority in whom the disease will remain dormant for a logical period of time, it is HIS decision. 8. Intermittent Therapy: If undetectable presence of the disease and a low PSA (less than 1.0) is accomplished after CHT this attitude may be considered. PSA must be monitored on a minimum 3 month frequency and if the PSA rises more than .75 in 2 consecutive blood tests, treatment must be resumed without delay. CAUTION: Hormonal refraction cannot be determined until all the CHT medications have been administered. Only then can hormonal therapy be considered refractory and Chemo-therapy be instituted. A list of the antiandrogens is contained in No.1. above. We highly advise that ALL patients maintain complete records of every visit to your physician(s), clinics, laboratories etc. After all, you are the patient, you are the one who has the disease, you are the one who is footing the bill whether it is by insurance, Medicare, Medicaid or cash. The money paid in to your HMO is for your treatment. Do not permit them to deny you your treatment of choice, nor the type of physician you prefer. Keep them in a safe place and when it is desirable to consult them see to it that they are in folders and in your briefcase in an easily accessible order. Remember you are in control of your own destiny. Protect your constitutional rights at all times. In considering the potential side effects of treatment we are forced to acknowledge the fact that NO two individuals are biologically constituted the same. Reactions to any form of treatment are not predictable except for generalization. The random classification of patients used to delay or postpone treatment are based on assumptions. Once the presence of the disease has been confirmed watchful waiting is only courting disaster and hormonal blockade should be com-menced immediately SIDE EFFECTS: Nearly all side effects have definitive methods of treatment. Some may have more than one. Some of the more common are: Gynecomastia - tenderness or enlargement of the breasts. Diarrhea - liquid stool Hot Flashes Impotence - termination of sexual abilities. Incontinence - uncontrollable urination Red blood corpuscle deficiency White blood corpuscle deficiency Pain New devises and medications are being introduced all the time, and as they are submitted to us we thoroughly investigate each to determine that there is sufficient evidence of authenticity before we will publish the relevant information in the Newsletter. There are those who will seize on the opportunity of promoting their own financial welfare by preying on the fact that the patient has been informed that they have a life-threatening disease and are prone to believe anything that they hear. It is abject stupidity that denies the efficacy of COMPLETE Hormonal Blockade as the initial form of treatment. CHT will down-stage both the prostate gland and the tumor volume. Don't believe all you hear and only half of what you see. On the other hand, you are the one in the driver's seat. ALTERNATIVE THERAPIES: Recently Nov. 28, 1997 CNN broadcast a half hour news release on the merits of alternative therapies. The definition of ALTERNATIVE is "Instead of" which advocates a substitute for present acceptable methods of treatment. The definitive conclusion was that the promotion of these alternatives was MEDICAL FRAUD and patients were warned that the news releases and other methods used to influence patients to add to or substitute for proven treat-ment were invalid. In nearly all cases the same results were attained when NOT using the alternative medica-tions and equipment. It is true that there are self-interested individuals groups and organizations who will influence the legislative approval because it restricts their income and highlights their lack of knowledge. A good example of the incapability of the medical profession is displayed with the lack of approval of Cryosurgery. Of the 140 plus units currently in use and the dismal failures at over 100 centers offering the treatment, it is neither the treatment nor the equipment that is at fault. When one such center has treated over 600 patients with a 90+ percentage of success there must be a reason for such malpractice. Once again, we reiterate; it is the patients right to choose their physician, method of treatment, and be responsible for the eventual outcome.
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