Prostate cancer is the second most prevalent cancer in men. Many men are diagnosed with localised prostate cancer, this is cancer that has not spread beyond the prostate gland.
It is best to think of the early stages of prostate cancer as being localised to the prostate gland and thereby curable.
Late stage prostate cancer involves the cancer having spread to the bones or lymph nodes. This type of cancer is not currently curable, however with modern methods it can certainly be controlled, often for many years.
By considering the different prostate cancer stages, there are a different types of prostate cancer treatments that may help.
- What are the five early warning signs of prostate cancer?
- What should a patient consider before choosing a prostate cancer treatment?
- What are the best medical treatments for early stages of prostate cancer?
- What are the best medical treatments for late stages of prostate cancer or advanced prostate cancer?
- Types of prostate cancer treatment
- What is the latest treatment for prostate cancer?
- Are there prostate cancer treatment side effects?
- What do prostate cancer treatments cost?
What are the five early warning signs of prostate cancer?
Men with a family history of prostate cancer, especially with a brother or father having had prostate cancer, have a three times increased risk of getting prostate cancer themselves. They should therefore undergo annual screening with a digital rectal examination and PSA blood test from the age of 40 years.
Obese men and men who do not exercise are at increased risk of contracting prostate cancer.
It is possible that men with a high daily alcohol consumption are more likely to contract prostate cancer.
Men with a rising prostate specific antigen blood test are at risk of having prostate cancer and need to be referred to a specialist urologist.
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. A patient might consider or search for stage 2 prostate cancer treatment or stage 3 prostate cancer treatment, but the more effective way to think about prostate cancer treatment is to understand whether it is low grade or high-grade.
What are the best medical treatments for early stages of prostate cancer?
Patients may be wondering what is the best treatment for prostate cancer in early stages. There are a few options to consider.
Low grade localised prostate cancer
Low-grade prostate cancer is a very common occurrence and does not need radical treatment. Men with low grade prostate cancer are placed into an active surveillance program whereby the PSA is monitored on a regular basis and from time to time a multi-parametric MRI scan performed.
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 should assume the responsibility of and adhering to the follow-up recommendations.
High-grade localised prostate cancer
Depending on patient factors, men with high-grade localised prostate cancer will be treated with either radical prostatectomy surgery/prostate cancer surgery or radiation therapy. When the prostate cancer is diagnosed at an early stage and when it is confined to the prostate, there is a significant chance of cure.
Younger men with high-grade disease and especially those with obstructive urinary symptoms are best managed with radical prostatectomy. Older men with obstructive symptoms are still best managed with surgery as surgery treats the obstruction and cancer at the same time. Older men 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.
What are the best medical treatments for late stages of prostate cancer or advanced 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 main treatment is to remove testosterone from the body as testosterone fuels prostate cancer. Testosterone is removed by either removing the testes or alternatively by administrating a drug by injection every three months.
Significant advances have been made in the treatment of late stage prostate cancer, these advances include new drugs such as Abiraterone and Enzalutamide. There are also new chemotherapy protocols available.
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.
Types of prostate cancer treatment
There are 3 effective prostate cancer treatment and management recommendations. Localised prostate cancer is managed by either:
- Active Surveillance
- Radiation Therapy
- Radical Prostatectomy Surgery
Active surveillance prostate cancer treatment
Many men have low grade and low stage prostate cancer that does not require treatment. This is because this stage of prostate cancer is considered very slow growing and does not represent a risk to life. The risk of it spreading is minimal.
Active surveillance for prostate cancer is considered an appropriate treatment. 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.
Radiation therapy for prostate cancer treatment
Radiation therapy for prostate cancer treatment is another type of treatment. 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 for prostate cancer when externally delivered generally involves visiting the radiation oncology unit everyday, 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 for prostate cancer treatment
Radical prostatectomy for prostate cancer is another option. 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.
What is the latest treatment for prostate cancer?
Modern new diagnostic techniques in the latest treatment for prostate cancer treatment include multi-parametric MRI scanning which increases the accuracy of diagnostic testing and allows the diagnosis of prostate cancer at an earlier stage. Importantly MRI scanning has significantly reduced the incidence of unnecessary prostate biopsies.
PSMA PET scanning is also proving very useful at staging prostate cancer, this helps determine the extent of the disease such that appropriate therapy can be individualised for each patient.
Robotic surgery techniques and radiation therapy are other modern techniques which are constantly being improved and refined.
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.
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.
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.
- Fahmy O, Alhakamy NA, Ahmed OAA, Khairul-Asri MG, Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis, Cancers (an open access journal of oncology), 5 Dec 2021
- Merriel SWD, Funston G, Hamilton W, Prostate Cancer in Primary Care, Advances in Therapy, Sep 2018.
- Kinsella N, Helleman J, Bruinsma S, Carlsson S, Cahill D, Brown C, Van Hemelrijck M, Active surveillance for prostate cancer: a systematic review of contemporary worldwide practices, Translational Andrology and Urology, Feb 2018.