What are some of the treatment options for prostate cancer?
The treatment options for prostate cancer depend in part on your age, your overall health and whether the tumor has spread. For tumors that are still inside the prostate, radiation therapy (using a type of X-rays to kill the cancer cells) and a surgery called radical prostatectomy are common treatment options. "Watchful waiting" is also a treatment option. In this approach, no treatment is given until the tumor gets bigger. Watchful waiting may be the best choice for an older man who has a higher risk of dying from something other than his prostate cancer.
Usually, tumors that have grown beyond the edge of the prostate can't be cured with either radiation or surgery. They can be treated with hormones that slow the cancer's growth.
What is radical prostatectomy?
Radical prostatectomy is a surgery to remove the whole prostate gland and the nearby lymph nodes. After the prostate gland is taken out through an incision, a catheter (a narrow rubber tube) is put through the penis into the bladder to carry urine out of the body until the area heals.
Other kinds of prostate surgery are less invasive and have different risks and recovery rates. Your doctor will help decide which type of surgery is the best option for you. Laparoscopic surgery helps the surgeon see inside your body using a thin tube with a tiny camera attached to it. Small cuts are made near the tumor site, and thin tools are used to remove the tumor and surrounding tissue. Some hospitals also have robots to assist in this kind of surgery. The doctor operates the robot arm from a computer.
Your doctor will talk to you about the kind of anesthesia used during surgery. You may be given general anesthesia, which puts you into a sleep-like state. Or an epidural or spinal anesthesia may be given instead. This kind of anesthesia blocks nerve routes from the spine and numbs the area.
What are the risks and benefits of radical prostatectomy?
If you're young and in good health, the short-term risks of this surgery are low. The hospital stay is usually 2 to 3 days, with the catheter left in place for 2 to 3 weeks. You're usually able to go back to work in about 1 month. You shouldn't have severe pain with this surgery. Most men regain bladder control a few weeks to several months after the surgery.
The main advantage of surgery is that it offers the most certain treatment. That is, if all of the cancer is removed during surgery, you are probably cured. Also, the surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor.
Surgery does have risks. The main risks of radical prostatectomy are incontinence (loss of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Most bladder and impotence problems improve with time.
Fortunately, only a very low percentage of men have severe incontinence after radical prostatectomy. Up to 35% of men have some accidental leakage of urine during heavy lifting, coughing or laughing. The chance of impotence (erectile dysfunction) is lower if the surgeon is able to avoid cutting the nerves. This may not be possible if the tumor is large. Your age and degree of sexual function before the surgery are also important factors. If you're younger than 50 years of age when you have this surgery, you're likely to regain sexual function. If you're older than 70 years of age, you're more likely to lose sexual function. Remember, even if the nerves are cut, feeling in your penis and orgasms remain normal. Only the ability to get a rigid penis for sexual intercourse is lost. However, there are medicines and devices that can help make the penis rigid.
You could lose a lot of blood during this surgery. Before the surgery, you might want to save about 2 units of your own blood in case you need a transfusion.
What is radiation therapy? What are its risks and benefits?
There are 2 types of radiation therapy. In one type, called external (beam) radiation therapy, radiation is given from a machine like an X-ray machine. In another type -- internal radiation therapy -- radioactive pellets (called "seeds") are injected into the prostate gland. This is sometimes called seed therapy or brachytherapy (say: "brake-ee-ther-uh-pee"). Both types have about the same results in curing prostate cancer.
The external beam radiation therapy is usually only takes about 10 minutes, but it is given 5 days a week over 6 to 8 weeks. Some people might find this time-consuming. However, you don't need any anesthesia for this kind of treatment. The side effects are milder than the side effects that can occur with seed therapy.
Seed therapy can be done with just one hospital visit. For seed therapy, you’ll need to have anesthesia for a few minutes, but you should be able to go home right after the treatment. In seed therapy, higher doses of radiation can be put right into the cancer. You may feel more discomfort after this treatment.
Older studies show that about one half of patients become impotent within 5 years of having radiation therapy, but newer forms of radiation may have different outcomes. Many men feel very tired at the end of the treatment period. About 15% to 30% of men who have radiation therapy have side effects like urinary burning, urinary bleeding, frequent urination, rectal bleeding, rectal discomfort or diarrhea during or shortly after the treatment. Erectile dysfunction (impotence) is a common side effect and it often gets worse over time. More serious complications are rare. However, a degree of uncertainty goes along with radiation treatment. Since the prostate gland and the lymph nodes are not taken out, your doctor can't tell the exact size of the tumor. The cancer could come back many years after radiation treatment.
At 10 years after treatment, cure rates are about the same for radiation therapy and radical prostatectomy. Men who have radiation therapy avoid the risks of surgery. There is also no risk of bleeding. You don't have to stay in the hospital and you'll recover faster. Daily activities can usually go on during the treatment. Incontinence is extremely rare after radiation therapy. Surgery, however, may give you a better chance of cure over the long term.
What are the risks and benefits of watchful waiting?
Often, prostate cancers are small and grow slowly. Because many men with a slow-growing tumor have the same life expectancy as men who don't even have prostate cancer, it may not be necessary to treat very small, very slow-growing prostate tumors. Also, for some men, the side effects of treatment outweigh the benefits. During watchful waiting, you have no treatment, but you see your doctor often. If there's no sign the cancer is growing, you continue to have no treatment. Hormone therapy can be started if the cancer starts to grow.
It can be hard to tell if a small tumor will grow slowly or quickly. Your doctor will get clues about the way your tumor will grow by checking your prostate-specific antigen (PSA) level with a blood test, examining the biopsy tissue and giving you a rectal exam. The choice of watchful waiting is up to you.
What is the purpose of hormone therapy? Are there side effects?
The purpose of hormone therapy is to lower the level of male hormones, called androgens, which are produced mostly in the testicles. Androgens, such as testosterone, help the prostate tumor grow. Shots or pills can be given over a period of several months, or the testicles can be surgically removed. Once the testosterone is out of your body, the prostate cancer usually shrinks and new growth slows down. Hormone treatments are often used in combination with other kinds of prostate cancer treatments.
Hormone therapy does have side effects. Some of the more serious side effects include loss of sex drive, weakened bones, erectile dysfunction, fatigue and osteoporosis.
Hormone treatments are also used in patients who have cancer that has spread beyond the prostate gland. While prostate cancer that has spread usually responds to 1 or 2 years of hormone therapy, it does not cure the disease and most tumors eventually begin to grow again. Once this happens, the treatment goal is to control symptoms. No current treatment can cure prostate cancer once hormone therapy stops working. Recently however, chemotherapy has been shown to help some people who have advanced prostate cancer live longer.
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