Throw us a bone

by Donna Canada, RN, CURN

Alternative treatments or combination therapies may be a good choice for some men.

Treatment for prostate cancer is certainly not a "one size fits all" or "rubber stamp" of treatment protocols. There are many possible paths to take along the roadway of options. The treatment becomes more multi-focal when prostate cancer returns after initial treatment. At this stage, the combination treatments come into play.

Combination Therapy for Prostate Cancer

Data from a multinational clinical trial showed that men with advanced prostate cancer lived significantly longer when treated with radiation therapy (RT) and hormonal therapy (HT) compared with HT alone. Combination therapy reduced overall mortality by 23% and disease-specific mortality by 43% versus HT alone. The benefits accrued with no increase in toxicity, Padraig Warde, MBChB, reported at the 2010 American Society of Clinical Oncology (ASCO) meeting.

"We're confident that RT should be part of the treatment package in this group of patients," said Warde, of the University of Toronto and Princess Margaret Hospital. "It's interesting to note that it's possible that we underestimated the benefit of R.T. With the changes in technology over the past decade, radiation oncologists have been able to put much higher doses of RT into the prostate than used in this study."

Though widely used to treat prostate cancer, RT had an undetermined impact on survival in men with locally advanced disease. To address that void, investigators in Canada, Europe and the US conducted a randomized, controlled clinical trial of HT with or without RT.

"We feel that we've shown that patients treated with combined treatment, RT and HT, live longer and are less likely to die of prostate cancer, said Warde. RT gave very little in side effects.⁶

As has been mentioned elsewhere, radical prostatectomy cures many men but unfortunately, about one third of men who have had surgery will suffer from the symptoms caused by metastasis and die of their disease according to Eisenberger.³ Hormone therapy and chemotherapy (and combinations of them) are not considered "curative" because they do not eliminate the prostate cancer cells. These treatments are considered "palliative" with the goal to slow down the progression or spread of the prostate cancer.

Alternative Therapy for Prostate Cancer

Alternative medicine or treatment (treatment that is different from accepted therapies) is commonly used in the US, where more visits are made to alternative health providers than to primary care providers.^1(p142)

Common alternative therapies are: acupuncture, biofeedback, chiropractic, energy healing, herbal medicine, homeopathy, hypnosis, imagery, massage, relaxation techniques, and vitamins and minerals.

The National Institutes of Health have approved the use of acupuncture for relief of postoperative pain and pain associated with chemotherapy.

Advantages of acupuncture

• May help relieve cancer-related pain
• May help chemotherapy-induced nausea
• May affect the immune response
• Tends to promote more self-control and involvement by the patient in his treatment
• May be covered by some insurance companies
• Side effects are minimal if the acupuncturist is well trained

Disadvantages of acupuncture

• Limited studies are available comparing a placebo with acupuncture
• No specific studies are available regarding the use of acupuncture in advanced prostate cancer
• The patient needs to assess whether the acupuncturist is well trained
• If the acupuncturist is inexperienced, there is risk of infection and injury¹

The dietary therapies that are utilized are usually lycopene (found in tomatoes), green tea, red wine and soy products. Lycopene's role in prostate cancer prevention is controversial. Diets high in fruits and vegetables are thought to prevent prostate cancer and recurrence, but the research evidence is not strong.

Herbal remedies can be risky due to interactions with other medications and should always be reviewed with your physician.

References:

1. Ellsworth P. 100 Questions & Answers About Prostate Cancer.2nd ed. Sudbury, MA: Jones and Bartlett Publishers; 2009.
2. American Cancer Society, Bostwick D, Crawford ED, Higano C, Roach M, eds. Complete Guide to .Atlanta, GA: ACS Health Promotions; 2005.Prostate Cancer
3. Walsh PC, Worthington JF. Dr Patrick Walsh's Guide to Surviving Prostate Cancer" 2nd ed. New York, NY: Wellness Central; 2007.
4. Scholz, M. Newly Diagnosed Prostate Cancer: Evaluating The Options -- Part 2 Of 3. CRI Insights [online] August 2003 vol. 6, no. 3, Available at: http://www.prostate-cancer.org/pcricms/node/141#ADT. Accessed on September 11, 2010.
5. Vogelzang, 2010 American Society of clinical Oncology Annual Meeting. August 2010 article: Cabazitaxel New Chemo Approved for Advanced Prostate Cancer. Available at: http://www.ustoo.org/PDFs/HotSheets/HotSheet082010.pdf . Accessed on September 11, 2010.
6. Warde, 2010 American Society of clinical Oncology Annual Meeting. July 2010 article: RT Shown Beneficial for Prostate Cancer Subset. Available at: http://www.ustoo.org/Hot_Sheets.asp. Accessed on September 11, 2010.
7. Crouzet, 2010 American Urological Association Annual Meeting Retrieved from July 2010 article: High Intensity Focused Ultrasound Noninferior to External Beam RT for Prostate Cancer. Available at: http://www.ustoo.org/Hot_Sheets.asp. Accessed on September 11, 2010.
8. MSNBC. FDA approves new drug for prostate cancer (press release). Available at: http://www.msnbc.msn.com/id/36853649/ns/health-cancer/. Accessed September 14, 2010.

This article has been reviewed by a member of the Wellness Partners Editorial Board.

Posted September 2010