Dr. MJ Bazos MD,
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
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
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
What are its risks and
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
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
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
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
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
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.