Prostate Cancer Treatments: Comparing Cytotoxic Chemotherapy

Introduction: Prevalence and Challenges of Prostate Cancer

Prostate cancer is regarded as the most common cancer among men and contributes to approximately 29,000 deaths annually in the United States. It is estimated that close to 60% of elderly men in the United States are suffering from prostate cancer, though most are unaware of their condition. However, many older men are learning about their diagnoses through new screening tests that have become prevalent across the country. The severity of prostate cancer among elderly men is attributed to the fact that it generates secondary conditions that worsen a patient's overall health. It is estimated that nearly 20% of men with this condition have metastatic disease, while others develop metastases regardless of treatment with radiotherapy or surgical procedures.

Most elderly men who suffer from prostate cancer have had to make decisions regarding treatment options together with their doctors while facing significant uncertainty about the natural history of the disease and the effectiveness of therapy. Current treatment options are based on available general information concerning the prognosis of localized cancer. The best indicator of the spread of the disease and ultimate cancer-related death is the histologic characteristics of a tumor, commonly referred to as tumor grade. In addition to limited information about prostate cancer generally, little information is available regarding the impact of existing treatment options such as radiation, radical prostatectomy, and watchful waiting accompanied by active treatment in cases where the cancer spreads beyond the prostate.

Overview of Available Treatment Options

Given the availability of different treatment approaches for prostate cancer, the patient and his doctor share responsibility for choosing the most suitable and effective treatment method. The most commonly used treatment methods include active surveillance, radiation therapy, surgery, hormone therapy, chemotherapy, biological therapy, cryotherapy, and high-intensity focused ultrasound ("How is Prostate Cancer Treated?" 2014). However, selecting the most suitable treatment is a relatively difficult process that requires knowledge of the available options as well as information about the type and stage of the condition. The complexity of this process is further compounded by the varying benefits and side effects associated with each treatment option.

The Role of Clinical Trials in Treatment Evaluation

Clinical trials for prostate cancer utilize new treatment options to examine their safety and effectiveness. This is primarily because randomized clinical trials are the gold-standard measures for evaluating hypotheses regarding treatment effects. These randomized trials tend to be effective in reducing risk by randomly allocating patients to treatment groups. Nonetheless, only one clinical trial has been conducted comparing surgical treatment with watchful waiting, and it demonstrated no significant difference in outcomes. The benefit of any given treatment option differs among treatment groups based on crucial factors such as age, tumor grade, and tumor stage.

Cytotoxic Chemotherapy as a Primary Intervention

Cytotoxic chemotherapy has proven to be an effective intervention that prolongs the survival of elderly men with hormone-refractory prostate cancer, unlike radical surgery, radiation therapy, or watchful waiting (Hricak, 2014). Radical surgery, radiation therapy, and watchful waiting represent alternative treatments that have become more widely available. Clinicians who support the use of these alternatives face significant challenges and weak foundations for their arguments due to the limited information available about them (Wasson et al., 2009, p. 493). These treatments can only be more strongly advocated after various improvements are made in prostate cancer management.

One area requiring improvement to enhance the effectiveness of currently available alternative treatments is the lack of standardized reporting. Factors with an inherent potential to bias or confuse the interpretation of studies should be reported in standardized ways, particularly in relation to age, grade, stage, and comorbidity. Additionally, these treatments would benefit from systematic documentation of changes in patient function or health status, given their significance from the patient's perspective. Finally, the effectiveness of these treatment alternatives can be better ascertained through clinical trials and patient series that employ standardized reporting techniques.

Cytotoxic therapy has proven to be the most effective intervention for patients with hormone-refractory prostate cancer by significantly prolonging survival (Tannock et al., 2004). Generally, chemotherapy has the ability to decrease serum PSA levels in hormone-refractory prostate cancer patients and reduces pain in some patients. While tolerability remains a major concern surrounding the use of this treatment option, it has proven to relieve pain and enhance quality of life based on the findings of a randomized clinical trial. Moreover, analysis from that trial demonstrated that docetaxel with prednisone is the most preferred alternative for many patients suffering from hormone-refractory prostate cancer.

Chemotherapy may broadly be understood as the use of specialized drugs to kill or shrink cancerous cells. These drugs range from oral pills to medicines administered intravenously, or a combination of both. Unlike other treatment alternatives, chemotherapy appears to be the most effective option for relieving pain and enhancing quality of life by reducing or eliminating the cancer. The use of cytotoxic chemotherapy on patients with hormone-refractory prostate cancer is based on the premise that treatment of this condition is palliative in nature. The use of primary androgen ablation results in symptomatic improvement and a decrease in serum levels of prostate-specific antigen. However, in nearly 80% of patients, the disease ultimately becomes refractory to hormone treatment. In this context, hormone therapy appears ineffective, particularly when combined with external irradiation, raising numerous clinical questions and concerns. This implies that hormone therapy does not prolong survival in these patients to the degree that cytotoxic chemotherapy does, given the latter's demonstrated capacity to enhance quality of life.

Conclusion: Toward More Effective Treatment

There is a need for more information about the natural history of prostate cancer in order to understand and develop the most suitable treatment options based on tumor grade and stage. While some treatment options have been controversial, these alternatives have proven effective in certain cases and ineffective in others. Healthcare professionals and practitioners should work toward generating more information about the presently available alternative treatment options in an effort to enhance the effectiveness of prostate cancer treatment.

The identification and development of new, more effective treatment alternatives will help lessen the burden of the disease among elderly men. The prevalence of prostate cancer in this population underscores the need for effective treatment approaches and health practices that will reduce both the risks and effects of the disease. This process requires a thorough evaluation of each available treatment with respect to its effectiveness and clinical outcomes.