Treatment choices for most prostate cancer patients with cancers detected early
are varied and the ideal treatment ultimately depends on many factors. These
include prostate cancer characteristics, overall health, your physician's
recommendations and of course, your preference.
For low risk prostate cancer patients--all of the listed options are
available. While high risk patients benefit from combinations of multiple
types of the options listed below. The intermediate risk group requires
special discussion with your physician as they may also need combinations of
treatments if patients are young and in good health. As well, special
circumstances may occur in your type of cancer where special combinations of
treatments may need to occur.
To determine your risk category of prostate cancer,
Radical
Prostatectomy: involves the surgical removal
of the prostate gland under anesthesia. There are many
different surgical techniques with varying outcomes and
complications. This procedure does require
hospitalization for at least several days and will require a
catheter in the bladder for certain length of
time.
Advantages: 1. Complete removal of
the prostate gland
2. Ability to determine the exact extent of cancer
in your prostate
3. Option for radiation therapy to follow if
needed
Disadvantages:
1. Incontinence (urinary
leakage): will occur in most patients initially and
subside -- but 5-15% of patients may experience long-term
problems with bladder control
2. Impotence (difficulty maintaining an
erection): can occur in up to 60-70% of patients but
with nerve-sparing surgery, this can be lowered to 30% in some
patients (depending on the type of surgery, the size of the
prostate, health of the patient and the extent of the cancer).
External
Beam Radiotherapy: involves receiving
daily radiation treatments from a high-energy x-ray machine
(linear accelerator). The high energy radiation leads to
damage of the DNA of the cancer cells preferentially while
having a less damaging effect on non-cancerous tissue.
Patients will receive radiation treatments daily (Monday -
Friday) with each visit lasting about 20 minutes.
Treatments are generally the same time each day and will
generally continue in the case of prostate cancer for up to
8.5 weeks. The treatments once started must be
continously received (with no major breaks in treatment except
for weekends and holidays) to be effective.
Radiation therapy has evolved rapidly in the past 40
years. Treatment 40 years ago was commonly
associated with major skin changes and moderate bladder and
bowel complications due to an inability to control the
radiation being delivered outside of the prostate to normal
tissues. But newer technologies have now evolved
allowing for more accurate delivery, more focused treatment,
leading to much lower complications rates, eg. 3D conformal
radiation therapy. In the past few years, most
centers have begun introducing IMRT (intensity modulated
radiation therapy) which allows even more accurate
radiation delivery and control--allowing oncologists to
deliver higher dose of radiation to certain parts of the
prostate (ie. cancer) but sparing the normal tissue around the
prostate.
Treatment in
1960s
Treatment in
1980s
Treatment in 2000s
For more information on IMRT,
Advantages of Radiation Therapy: Patients do
not undergo any surgical procedure whatsoever. Patients
can usually continue to work (if they wish) and function
normally with no special concerns about changes in their daily
activity, diet, exercise, etc.
Disadvantages of Radiation Therapy:
1. Bowel & Bladder Effects: most
patients will experience a certain degree of bladder and bowel
irritation leading to more frequent urination, sometimes
burning, soft bowel movements or diarrhea. These side
effects generally disappear 2-3 weeks after radiation therapy
but may last longer depending on your radiation dose, size of
your prostate and your overall health.
2. Impotence: about 50% of patients will
experience some degree of erectile dysfunction. This
increases with the age of the patient and is also higher if
you have diabetes, cardiac problems or currently take blood
pressure or antidepressant medications. Medications like
Viagra and Levitra may be effective in some patients that have
developed erectile dysfunction after radiation therapy.
Seed
Implants: involve a short (1 hour)
outpatient surgical procedure where radioactive seeds are
placed into your prostate gland. The seeds give off a
low dose of radiation which leads to DNA damage of the
prostate cancer cell. The dose is generally not high
enough to lead to damage organs far away from the prostate
gland.
to see a detailed description of prostate seed implants.
Advantages: 1. Short outpatient
procedure (1hr)
2. Lowest impotence rates as compared to the other
treatments --
Impotence -- 15-25% (rates best with
younger age)
3. Lowest incontinence rates as compared to the other
treatments (< 1%)
4. Published data indicates that seed implants are
equally effective at curing the prostate cancer (in early
stages) as surgery and radiation therapy.
Disadvantages: 1. Patients will
experience a significant degree of urinary burning, frequency
(day & night) in the first 2-4 weeks--greater than the
other treatments listed above. This can be usually managed with
various medications in most cases.
2. Patients will be mildly radioactive from the seeds
and special restrictions need to be followed in the first 30
days for pregnant women or children around the patient (click
the link above for more information). There are major
restrictions for spouses or partners after the
implant.
HDR
(high dose rate) Implants: involves
the placement of hollow plastic catheters into the prostate
under anesthesia and with ultrasound guidance in a technique
similar to the prostate seed implant. The major
difference is that there is no radioactivity involved during
the surgical procedure or any risks of radiation safety after
the patient leaves the hospital. The major advantage is
that radiation can be accurately delivered to the prostate
gland/cancer minimizing dose to the surrounding normal tissues
in a manner more precise than most other forms of
radiotherapy.
to see a detailed description of prostate HDR implants.
Advantages:
1. Radiation is
precisely delivered to the prostate cancer (important for
intermediate or high risk
cancers where precision is critical).
2. Radiation is
precisely minimized to normal healthy tissues
3. Short
hospitalization (2-3 days)
4. Rapid recovery
(urination & bowel irritation)
5. No radiation safety
concerns for the patient
Disadvantages:
1. Most patients will
require 5 weeks of external beam following HDR
2. Long term data over
5 years has not yet matured however some current published
data demonstrates superiority of HDR + external treatment over
external beam treatment alone.
to view the journal article.
3. Prostatectomy
following HDR treatment is usually not possible in the event
of recurrence.
