Dr. MJ Bazos MD, Patient Handout
Prostate Cancer Treatment Options
What are some of the treatment options for prostate cancer?
The treatment options for prostate cancer depend in part on whether the tumor has spread. For tumors that are still inside the prostate, radiation therapy (using x-rays that 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.
Generally, 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 the surgical removal of the whole prostate gland and the nearby lymph nodes. Most men who have this surgery are under general anesthesia (puts you into a sleep-like state). After the prostate gland is taken out, 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.
What are its risks and benefits?
If you're 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 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 lymph nodes are taken out along with the tumor.
Surgery does have risks and complications. 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. The main risks of this surgery are incontinence (lack of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Fortunately, a very low percentage of men have severe incontinence after radical prostatectomy. Up to 35% of men have a little accidental leakage of urine during heavy lifting, coughing or laughing.
The chance of impotence decreases 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 under 50 when you have this surgery, you're likely to regain sexual function. If you're older than 70, you're more likely to lose sexual function. Remember, even if the nerves are cut, feeling in your penis and orgasm 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.
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, radioactive pellets (called "seeds") are injected into the prostate gland. This is sometimes called seed therapy or brachytherapy (say "break-ee-ther-uh-pee"). Both types work about the same in curing prostate cancer.
The machine therapy is usually given 5 days a week over 7 weeks, which you might find time-consuming. However, you don't need any anesthesia. The side effects are milder than the side effects that can come with seed therapy. However, seed therapy can be done with just one hospital visit. You would have 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 on the cancer. You may feel more discomfort after this treatment.
Radiation therapy has a cure rate about the same as the cure rate for surgery, but no surgical risks. There's no risk of bleeding. You don't have to stay in the hospital. You'll recover faster. Daily activities can usually go on during the treatment. Incontinence is extremely rare afterward.
About one half of patients become impotent within 2 years of having radiation therapy. Many men feel very tired at the end of the treatment period. About 15% to 30% have urinary burning, urinary bleeding, frequent urination, rectal bleeding, rectal discomfort or diarrhea during or shortly after the treatment. 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, the doctors 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. However, surgery may give you a better chance of cure over the long term.
What are the risks and benefits of watchful waiting?
Many 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, some men feel that the side effects of treatment outweigh the benefits. In watchful waiting, you get no treatment, but you see your doctor often. If there's no sign the cancer is growing, you continue to get no treatment. Hormone therapy can be started if the cancer starts to grow.
It can be hard to tell if a small tumor is going to grow slowly or quickly. Your doctor will get clues about the way your tumor will grow by checking your PSA level, examining the biopsy tissue and giving you a rectal exam, but the choice of watchful waiting is up to you.
What is the purpose of hormone therapy?
The purpose of hormone therapy is to remove the male hormones, called androgens. This is because androgens, such as testosterone, help the prostate tumor grow. Monthly shots can be given or the testicles can be surgically removed. Once the testosterone is out of your body, the prostate cancer usually shrinks. Hormone treatments are most often used in patients with cancer that has already spread beyond the prostate gland.
While prostate cancer usually responds to 1 or 2 years of hormone therapy, after some time most tumors start to grow again. Once this happens, the treatment goal is to control symptoms. No treatment can cure prostate cancer after hormone therapy stops helping.
Who can I contact for more information about prostate cancer?
Your family doctor, your oncologist (cancer doctor), the radiotherapist and your urologist can give you information. Your local hospital or cancer center may refer you to a local prostate cancer support group, where you can meet other men who have had this cancer. The organizations listed below can also give you more information as you make your decision about prostate cancer treatment.
Prostate Health Council/American Foundation for Urologic Disease: www.prostatehealth.com
American Cancer Society: www.cancer.org
US TOO International, Inc.: www.ustoo.com