The Three Main Treatment Options for Prostate Cancer
This article is not intended to replace professional medical care or advice. If you have any questions or need additional information, please talk with your doctor.
Timing and identifying the stage of prostate cancer varies among individuals, and as such, the method of treatment should be customized accordingly. Choosing a treatment option is ultimately up to the individual and depends on factors such as risk level, the stage of the cancer, personal health and circumstances, the need for therapy and the individual’s opinion of the risks and benefits of each option. The best way to make an informed decision is through education and discussion with a physician, specialists and family members.
It’s important to get a second, and even third, opinion
Consultation and screening
Initial consultation begins with your primary care physician. Even for those who are not experiencing any symptoms of prostate cancer, a screening may be used to test for signs. Screening, asserted the Prostate Cancer Foundation (PCF), is a personal decision within itself. As with treatment options, there are some who believe that screening can be beneficial while others believe it may do more harm than good. If a screening or other additional symptoms show signs of prostate cancer, your physician will perform a digital rectal exam (DRE) and a prostate-specific antigen (PSA) test. Your doctor will then recommend you to a urologist who will perform a biopsy and likely repeat the PSA and DRE.
As always, it is important to get a second, and even third, opinion and conduct your own research to reach an un-biased, educated decision for how to move forward. Patients are also advised to utilize outside sources such as family, friends, support groups and others undergoing similar circumstances to make an unbiased decision. After a comprehensive analysis, most patients decide on one of the three most popular options for treating the disease – active surveillance, surgery or radiation therapy.
It is not always necessary for those diagnosed with cancer to be treated right away. Active surveillance or watchful waiting are often suggested when prostate cancer is found in the early stages and is slow growing, low risk and shows minimal cancerous tissue, reported the American Cancer Society (ACS). These two approaches are also common for older men, those with serious health concerns and for those who choose to avoid the potential side effects of treatment for as long as possible.
Active surveillance closely monitors prostate cancer with routine ultrasounds, digital rectal exams and prostate-specific antigen blood tests every few months that identify cancer growth or signs of progression. A repeat prostate biopsy may also be conducted after one year to ensure that the cancer is not spreading or becoming more aggressive. Extreme developments, changes or rising PSA levels may warrant looking into other treatment options. When the cancer is not causing any symptoms and is expected to grow very slowly, an even less hands-on approach may be used, noted the ACS. Watchful waiting requires fewer tests and continuously oversees a patient’s condition without providing any treatment – until symptoms appear.
Prostate radiation therapy uses directed radioactive exposure, such as high-energy x-rays, to kill cancer cells and surrounding tissues. There are multiple forms of radiation and the method used depends on the patient’s specific stage and type of cancer. The two most common types of radiation are external beam radiation therapy and brachytherapy, also known as internal therapy. EBRT is a machine outside of the body that sends radiation beams – shaped to fit the tumor – to kill the cancer. Internal radiation therapy uses a radioactive substance that is placed directly near or into the cancer through wires, seeds, needles or catheters. Those who use radiation treatment are at risk for a number of potential side effects including rectal pain and bleeding, urinary problems and impotence, according to the NCI.
However, there is now a method for reducing prostate radiation side effects during therapy. Spacing Organs At Risk, SpaceOAR is a game-changing innovation used with radiation. The ultimate goal of radiation is to amplify radiation to the prostate while avoiding damage to surrounding tissues and organs. Separated only by a very small space, radiation often unintentionally causes damage to the rectum. SpaceOAR hydrogel addresses that very drawback by temporarily moving the rectal wall away from the prostate during therapy.
Surgery may be used to stage, diagnose and treat prostate cancer, according to the PCF. A total or radical prostatectomy, the removal of the entire prostate gland as well as some of the surrounding tissue, is most common in men whose cancer is restricted to the prostate and those in the early stages of the disease. This surgery can be done open, laparoscopically or with robotics.
A robotic assisted laparoscopic radical prostatectomy (RALP) is the most common form of surgery performed today, according to the Urology Care Foundation (UCF). Using a robotic system that guides the laparoscopic surgical instruments and camera, the prostate is removed through ports in the stomach. Reconstruction of the bladder and urinary tract is done following the surgery. A catheter will be put in place for one to two weeks to help drain the urine as the new connection between the bladder and urethra mends itself. This new connection is called the anastomosis.
To help lower the risk of infection, suction drains may be left near the bladder to remove any fluid from the wound, according to the UCF. These drains will normally be removed before hospital discharge. In most cases, a bowel movement will not occur until three days after the surgery and passing gas may not happen for a day or two. Upon the return visit to the surgeon, the catheter will be removed.
Though no longer used as frequently, in an open or perineal prostatectomy the incision to remove the prostate is instead made in the area between the scrotum and the anus called the perineum, described the National Cancer Institute (NCI). If lymph nodes in close proximity need to be removed, that is done through a small incision in the abdomen. When surgery is performed laparoscopically, a video camera and small surgical tools fit through the incisions in the stomach to remove the prostate gland, reported the UCF. This method is now commonly replaced with robotic assisted laparoscopic surgery.
Both surgery and radiation come with a number of potential side effects and complications. With surgery, the most common post-operation complications include impotence, shortening of the penis and leakage of urine from the bladder and stool from the rectum. Some level of impotence following surgery is almost inevitable, according to the PCF. This is because the blood vessels and nerves responsible for making an erection happen are extremely fragile and can be easily damaged during the procedure, no matter how precise it was.
However, 40 to 50 percent of men who underwent a nerve-sparing prostatectomy will return to their pre-procedure function within one year after treatment, according to the PCF. Thirty to 60 percent will return to pre-procedure function within two years. Radiation and surgery treatment options both have their share of potential side effects.