Prostate Cancer Treatment Options
There are a number of different alternatives for the treatment of prostate cancer. One particular option may be appropriate in one patient and not in another. The treatment selected depends on a number of factors including your age, general health, aggressiveness of the cancer (Gleason number), whether or not your cancer is thought to be confined to the prostate, and most importantly, what type of treatment you are most comfortable with. In many patients there is no “best” treatment, but rather several different choices which may be appropriate. The following information is not meant to be complete; it is just a brief outline of many options.
1. Radical Prostatectomy: Surgery to remove the entire prostate. Men who choose this option typically have a life expectancy of at least 10 years and are generally in good health. There should be a high probability that the cancer is confined to the prostate. The entire prostate and the seminal vesicles (the structures that produce the semen) are removed. Patients typically spend 2 to 5 days in the hospital and wear a catheter for 1 to 3 weeks. Long term problems may include erectile dysfunction (impotence) and incontinence. This surgery can be done by a number of different surgical techniques including: (1) perineal, (2) abdominal/retropubic, (3) laparoscopic and (4) Robotic assisted laparoscopic.
2. External Beam Radiation Therapy: The typical patient receives one treatment a day, as an outpatient, 5 days a week for 5 to 8 weeks, the number of treatments is variable. Short term side effects may include rectal and bladder irritation. Long term complications may include erectile dysfunction (impotence), rectal ulcers and problems with urination. The most common type of radiation therapy is called “IMRT”.
3. Radioactive Seed Implant: This treatment (“interstitial brachytherapy”) involves inserting radioactive metallic “seeds” into the prostate. The procedure is done together by a urologist and a radiation therapist. Most patients go home the same day as the surgery. Some patients with more aggressive cancer are also advised to have course of external beam radiation therapy in addition to the seed implant. Short term problems may include difficulty with urination. Long term problems may include erectile dysfunction (impotence) and urinary problems.
4. Cryosurgery: Freezing the prostate is another option; this technology has made significant advances in the past 10 years. 2007 data shows disease free survival rates at 5 years for low-, moderate- and high-risk disease of 85%, 73% and 75% respectively. Long term survival rates are not yet available.
5. “Active Monitoring”: This means periodically monitoring the cancer without any treatment being given. This used to be called “Watchful Waiting”. In some patients, particularly the very elderly and those with significant other diseases this may be the appropriate choice. Patients are followed with PSA blood tests and physical exams. Other treatment may be started in the future if needed, usually “hormone treatment”.
6. “Hormone Treatment”: The male sex hormone, “testosterone”, is a stimulant to the growth of prostate cancer cells. Testosterone does not cause prostate cancer. However when testosterone is removed from the body by either surgical removal of the testicles, or by medication, many of the cancer cells will die. This may be used in men who have more advanced prostate cancer; it is also sometimes combined with surgery or radiation therapy. “Hot flashes” and erectile dysfunction usually occur with this treatment.
7. Chemotherapy: Chemotherapy may be used when prostate cancer has spread to the bones and hormone therapy is no longer effective in controlling the cancer. In very unusual circumstances chemotherapy may be used in newly diagnosed prostate cancer patients when the cancer is of a very unusual type.
8. “HIFU”: High Intensity Focused Ultrasound is a new treatment which involves delivering high intensity ultrasound to the prostate under a general anesthesia. At present this treatment is not approved by the FDA for treatment in the United States. As of 2009 there are no long term outcomes data for HIFU.