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 a surgery to remove 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 the risks and benefits of radical
prostatectomy?
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 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 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, only 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 years old 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. For seed therapy, you 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.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% of men who have radiation
therapy 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, 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. There are no surgical risks for men who have radiation
therapy. 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. 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 prostate-specific antigen (PSA) level, 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?
The purpose of hormone therapy is to lower the level of the male hormones,
called androgens, which are produced mostly in the testicles. 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.


What happens after prostate cancer treatment?
You should get PSA (prostate-specific antigen) blood tests every 6
months for 5 years, and then once every year. A rise in PSA levels
usually means that the cancer has come back. A digital rectal
examination should be done once a year.

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http://familydoctor.org/online/famdocen/home/common
/cancer/treatment/264.html