Prostate cancer that is localized is typically treated with radiation therapy or radical prostatectomy (excision of part or all of the prostate gland). This operation is performed through incision in the perineum, into the bladder, or through the urethra. Libido is typically unaffected by prostatectomy but some 30% of patients become impotent after the procedure.
A more common complication following a radical prostatectomy is the development of urinary incontinence. When disease has significantly progressed beyond this stage, or when the patient is very old or in poor health, these treatment approaches may not be used. These patients may be treated with irradiation, hormone therapy, or the surgical removal of the testicles. One of the hormonal therapies, oral diethylstilbestrol, has been given to prostate cancer patients in doses of 1 to 3 mg/day and has demonstrated some success over long periods of time. Long-term use of such estrogen therapies increases the risk of developing thromboembolic (blocking of a blood vessel by a thrombus) complications.
Additional adverse effects caused by estrogen therapies can include breast tenderness, breast enlargement, nausea, vomiting, loss of sexual desire, impotence, and water retention. Short-term use of agents such as high-dose diethylstilbestrol diphosphate can lead to substantial relief in patients within days. A variety of agents are used to decrease testosterone levels circulating in the body. These agents include flutamide, cyproterone acetate, ketoconazole, aminoglutethimide, and analog agents of luteinizing hormone-releasing hormone. Surgical removal of the testicles is sometimes performed when the disease has advanced or when hormone therapy has failed. The use of local radiation therapy has been found to be effective in relieving pain associated with cancer metastasis into the bones. Local radiation therapy can also help limit disease to the prostate.
Chemotherapy has generally not been effective once hormonal therapy has failed. It is also associated with severe adverse effects such as nausea, vomiting, lowered blood and immune system factors, and hair loss.
Benign Prostatic Hypertrophy
While BPH and prostate are not the same condition and are not believed to be related to each other, they have do have many common factors. As mentioned previously, both produce elevated PSA levels and a variety of problems relating to urination. In addition, both are believed to develop from hormonally-related factors. BPH occurs in more than half of all men in their 60s, and in as many as 90 percent of all men in their 70s and 80s.
BPH may develop from the growth of cells from the relatively increased levels of estrogen that occur in men as they age. Another line of thought states that the testosterone-derivative DHT2 is involved with the increased cellular growth associated with BPH. The drug called finasteride (Proscar), a 5-alpha-reductase inhibitor has reduced the size of the prostate in some patients, resulting in improved urination. BPH does not increase the risk of developing prostate cancer, and these two conditions develop in different parts of the prostate gland.
Source:Prostate Cancer Fund,(a special program of Project Cure Foundation) P.O. Box 96673, Washington, D.C. 20090-6673 • 1-800-716-2152. Photo courtesy of medicalcenter.osu.edu
September 22nd, 2008 
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