What is prostate cancer treatment?
Many men are diagnosed with localised prostate cancer, this is cancer that has not spread beyond the prostate gland.
There are 3 effective prostate cancer treatment and management recommendations:
Localised prostate cancer is managed by either:
- Active Surveillance
- Radical Prostatectomy Surgery or
- Radiation Therapy
Many men have low grade and low stage prostate cancer that does not require treatment. It does not require treatment because it is very very slow growing and does not represent a risk to life. The risk of it spreading is minimal.
Men on active surveillance to do need to be followed to ensure that high grade prostate cancer is not present or does not develop. The usual strategy is to check the PSA blood test every six months and to proceed to an MRI assessment of the prostate with or without a biopsy should there be a concern.
It is important that men on active surveillance keep their appointments over the years to ensure effective prostate cancer treatment and management.
Men with localised high-grade prostate cancer can be treated with external beam radiation therapy or brachytherapy. Brachytherapy is the implantation into the prostate gland of radioactive material.
Radiation therapy when externally delivered generally involves visiting the radiation oncology unit every day Monday to Friday for seven weeks. High-energy x-rays are directed onto the prostate gland. These have the capability of killing the prostate cancer cells.
After radiation therapy ongoing monitoring usually with a PSA blood test every six months is necessary in the long term.
Radiation therapy is potentially associated with side effects that may include radiation damage to the bladder and bowel and sexual capability.
Radical prostatectomy surgery
Men with high-grade prostate cancer are potentially cured of the cancer by removing the prostate gland, this operation is known as radical prostatectomy. The operation can be performed with the open or robot assisted laparoscopic technique. Some men are not suitable for robotic technology and they are well managed with the open surgical technique.
Modern surgical techniques aim to cure prostate cancer while minimising side effects. Side effects include urinary incontinence and erectile dysfunction.
Modern prosthetic urology is able to rehabilitate bladder and sexual function in men who suffered these complications.
Advanced prostate cancer
Men with prostate cancer outside of the prostate gland, in the lymph nodes all the bones are designated as having an advanced prostate cancer.
They are treated with either chemical or surgical castration, removing the hormone testosterone from the body generally allows for prostate cancer remission as evidenced by a falling PSA level. Many modern advances have occurred in the management of advance prostate cancer, these advances include the addition of second-line anti-androgen medications as well as the addition of effective chemotherapy.
Appropriately treated men with advanced prostate cancer can still enjoy a good quality of life. They should exercise daily and ensure that their vitamin D levels are normal as both these interventions ensure good bone and muscle health.
What should a patient consider before choosing a prostate cancer treatment?
When a patient is considering prostate cancer treatment, is highly advised to consider the pathology of prostate cancer. Which can be either low grade or high-grade:
Low-grade prostate cancer is considered to be in pathological terms Gleason grade 6. The standard treatment for low-grade prostate cancer is a strategy known as active surveillance. Active surveillance monitors the patient with six monthly PSA determination is, MRI as determined by the PSA trend and a follow-up biopsies at 2 to 3 yearly intervals depending on the clinical situation.
The reasoning behind active surveillance rather than active treatment for low-grade prostate cancer is that this type of cancer is very unlikely to progress locally or to spread beyond the prostate gland. It is this type of cancer that is best described as “more likely to die with rather than from prostate cancer.”
Men on active surveillance program is should assume the responsibility of and adhering to the follow-up recommendations.
High-grade prostate cancer requires definitive treatment with either radiation therapy or radical prostatectomy surgery. High-grade prostate cancer can be cured definitively if detected and treated properly in the early stages.
Younger men with high-grade disease and especially those with obstructive urinary symptoms are best managed with radical prostatectomy. Older man with obstructive symptoms are still best managed with surgery as surgery treats the obstruction and cancer at the same time. Older man with intermediate grade prostate cancer can generally choose between surgery or radiation therapy depending on the particular clinical situation.
Both treatment options have potential for side effects, these should be carefully explained to the patient and in the modern era side effects from treatment can in many cases be avoided and in nearly all cases mitigated with timely advice and interventions.
Metastatic Prostate Cancer
Metastatic prostate cancer is prostate cancer that has left the prostate gland and travel to either the bones or the lymph nodes. This type of cancer is not curable however in the modern era it can certainly be treated and maintained in remission often for many years.
The mainstay of management is androgen deprivation therapy, either removing the testes to remove testosterone or alternatively giving injections every three months to block testosterone production. Androgen deprivation therapy in conjunction with modern antiandrogen is and prostate chemotherapy and able men with metastatic prostate cancer to lead for an active life for many years in many cases.
What do prostate cancer treatments cost?
It is not possible to give a definitive answer to this question as it depends on each patient individual case.
The principal however is that as a patient you should obtain from the doctor’s office full financial consent before proceeding with treatment whether that treatment be surgery or radiation therapy.
At Katelaris Urology full financial information is given in a printed form and any questions answered. We ensure the patient is satisfied that they have a full understanding of what is involved financially.
Are there prostate cancer treatment side effects?
Yes, depending on the type of treatment you receive, there are some prostate cancer treatment side effects.
Radical prostatectomy side-effects
Urinary incontinence and erectile dysfunction are the commonest significant side-effects associated with radical prostatectomy surgery.
In order to prevent or minimise urinary incontinence the patient should commence pelvic floor exercise training before the surgery, stop whilst the catheter is in situ and recommence once the catheter has been removed.
The majority of men re gain to a large part urinary incontinence by six months. For men who do not regain urinary incontinence to effective operations are available, the male sling and the artificial urinary sphincter. For further information about these operations click here.
Erectile dysfunction is a side effect of surgery due to nerve damage. It can take up to 2 years to know whether or not the nerves will function again and during this period sexual rehabilitation with either penile injection therapy or Viagra type oral therapy is initiated to preserve the erectile tissue within the penis.
Four main who were suffering with erectile dysfunction preoperatively or for those men who do not regain sexual function post operatively the inflatable penile prosthesis is a highly effective means of restoring erectile function. For more information concerning penile prosthetic surgery click here.
Radiation therapy treatments may be associated with radiation damage to the bladder, this is known as radiation cystitis. This condition may cause blood in the urine and urinary frequency day and night. Depending on the severity of the radiation cystitis hyperbaric oxygen therapy may be necessary. Radiation therapy may also cause urethral stricture disease which may turn necessitate endoscopic surgery and stunting.
Radiation therapy may damage the rectum a condition known as radiation proctitis. Depending on the severity enema therapy may be necessary or once again hyperbaric oxygen therapy.