Prostate Cancer Treatment
Every man with prostate cancer is different and each treatment has different side effects and benefits. A treatment decision generally depends on the stage of your cancer and how far it has spread. If it is only in your prostate or the area around it, your doctor will likely recommend that it be treated locally with surgery and/or radiation therapy. If the cancer has metastasized, or spread to other parts of your body, you may also be treated with hormone therapy, chemotherapy and/or radiation therapy.
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Watchful Waiting [+] Surgery [+] Radiation Therapy [+] Hormone Therapy[+]
WATCHFUL WAITING
If your symptoms are not causing you any discomfort or problem, “careful observation” may be appropriate. In watchful waiting, the cancer is monitored very closely and treatment can be started immediately if the cancer advances. This works particularly well when the cancer remains in the prostate and has little effect on how you feel or on how long you will live. It is a fact that 7 out of 10 men with prostate cancer will die of other causes.
Choosing this option depends on:
- Whether you are having any symptoms
- Your age – in older men a small and slow growing tumour may not cause any problems during your lifetime
- Your health – if there are other serious illnesses you are suffering from
- How fast your cancer cells may grow
- How abnormal your cancer cells are
Some men may have difficulty accepting to NOT treat the cancer and would prefer treatment. For other men, the problems and side effects of treatment may seem worse than the benefits and watchful waiting is an appropriate choice.
SURGERY
Radical Prostatectomy
Treatment with this type of surgery is done in healthy men, usually under the age of 75, with early stages of prostate cancer. It removes the entire prostate gland, and seminal vesicles (these are just above the prostate and store semen). It is usually done through an incision in the lower abdomen and is called a radical retropubic prostatectomy.
Transurethral resection of the prostate (TURP) or Transurethral prostatectomy
This type of surgery does not remove the whole prostate and it not a cure. It is often done to help problems caused by the cancer, such as a difficult urine flow. Tissue is removed from the prostate through an instrument that is passed through the urethra (the tube that carries urine from your bladder out of your body). It is most commonly used to relieve symptoms of noncancerous growth of the prostate.
Possible Side Effects of Surgery
The major side effects of prostate surgery include erectile dysfunction and incontinence . Other complications such as infection and problems with the wound are a risk to any surgery.
RADIATION THERAPY
If cancer is only found in the prostate gland and it has not spread to other areas, your doctor may recommend radiation therapy or radiotherapy. Radiation therapy in some cases can be as effective as surgery when it is used during the early stages of cancer. Often it is the best option for those men who are unable to have surgery because they are older or have other medical problems.
While it is considered a good treatment option, it may not kill all of the cancer cells. There is a small risk that the tumour may grow back over a number of years.
Radiation therapy uses high-energy rays to damage cells and stop them from growing. There are different ways to administer radiation therapy.
External-beam radiation
A special machine is used to direct radiation beams at the tumour and surrounding areas. The treatment does not hurt and it lasts for only a few minutes. Usually the duration of treatment is for 6-7 weeks, or 30-35 visits.
“Conformal” radiation
This form uses the latest technology to make external beam treatments more accurate by targeting and shaping the radiation beam around the prostate gland. This applies a greater dose of radiation to the tumour and reduces the damage to healthy tissue around it. Long-term side effects have also been found to be less severe than with external-beam radiation.
Brachytherapy
This is also known as internal radiation therapy. Small, radioactive seeds are placed directly into your prostate. The seeds are safe and remain in place. This delivers a very high does of radiation to the prostate without affecting surrounding tissues. The seeds do not cause discomfort and will not make you radioactive.
Possible Side Effects of Radiation Therapy
Radiation can cause some normal, healthy cells to be injured during treatment. Usually these cells will recover and most side-effects will disappear over time. Side-effects usually appear during the 3rd or 4th week of treatment and can include:
- Tiredness – improves after treatment stops
- Rectal Problems – discomfort caused by diarrhea and rectal burning
- Urinary Changes – pain and burning while urinating
- Redness of the skin in the treatment area
- Over time, sexual changes such as a decrease in the amount of fluid ejaculated or inability to have or maintain an erection
HORMONE THERAPY
From the onset of puberty prostate cells divide and grow because of the male hormone testosterone, which is produced primarily in the testicles. Prostate cancer depends on male hormones, especially testosterone, to help it grow. Research has shown that reducing or “withdrawing” these hormones will cause prostate tumours to shrink. Hormone therapy works by getting rid of the testosterone made in the testicles and blocking its action – thereby starving the prostate cancer of the “food” it needs to grow. If the cancer has spread outside your prostate gland to other parts of your body (metastasized), hormone therapy can be used to slow the growth and reduce the size of your tumour. While hormone therapy can’t cure the cancer, it can sometimes improve the benefit of local treatment (surgery, radiation).
There are three different types of hormone therapy:
Orchiectomy
This is surgery to remove both testicles. It stops 90 – 95% of male hormone production. This surgery has few complications.
Luteinizing Hormone – Releasing Hormone (LH-RH) Agonists
This group of medications eliminate the body’s production of testosterone. They are injected once a month, or once every three months or once very four months. When used alone, these drugs stop the normal production of testosterone. These drugs produce few side effects except for hot flashes and other menopause-like symptoms.
Antiandrogens
Several types of antiandrogens are available for treating prostate cancer.
The most commonly used antiandrogens bind to prostate cancer cell and prevent androgens from getting into the cell to promote its growth. They do not stop the body from manufacturing testosterone.
Hormone therapy does not cure prostate cancer but it can slow the progression of the disease. At some point, treatment with hormone therapy may stop working. The cancer cells become resistant and begin to grow again. This is called hormone resistant or hormone refactory metastatic prostate cancer. If this happens, hormone therapy may be stopped.
OTHER TREATMENT OPTIONS
Chemotherapy
This treatment injects drugs into the veins. The drugs flow through the blood to all parts of your body to damage and kill cancer cells. This treatment option may be useful for advanced prostate cancer that has spread to other parts of the body.
Again, side effects can occur when the drugs damage healthy cells at the same time as the cancer cells. These side effects will go away with time as the body replaces the damaged cells.
Cryosurgery
This treatment kills cancer by freezing it. Complications are usually temporary and restricted to organs around the prostate that may also freeze. Currently this form of therapy has very limited use.
Thermotherapy
This treatment uses microwave technology to heat the prostate to kill cancer cells. This method is often used to treat men whose cancer has recurred after radiation therapy, but not yet spread outside their prostate. Currently this therapy is considered experimental in the treatment of prostate cancer.