Prostate Cancer Treatments – Surgery and Radiation Therapy

Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate gland. Prostate cancer is a disease no man wants to get. However, an estimated 15% to 20% of men are diagnosed with prostate cancer at some point during their lifetime. Men facing prostate cancer experience a wide range of emotions and fears about possible treatments, survival rates and cure. Prostate cancer or the side effects of the treatment often cause men to fear a loss of their masculinity. The primary psychosocial/emotional concern of men with prostate cancer is the possibility of impotence and incontinence.

canstockphoto7003255-surgery (420)

Once prostate cancer has been diagnosed, tests are performed to determine if cancer cells have spread either within the prostate gland or to other parts of the body. This process is called staging. Physicians must know the stage of the cancer in order to determine the appropriate treatment. The stages of prostate cancer are as follows:

Stage 1 prostate cancer is found in the prostate only.
Stage 2 prostate cancer is when the tumor has grown inside the prostate but hasn’t extended beyond it.
Stage 3 prostate cancer is when the cancer has somewhat spread outside the prostate possibly involving seminal vesicles.
Stage 4 prostate cancer is when the cancer has spread (metastasized) outside the prostate to other tissues.

Typically, stage 4 prostate cancer spreads to the lymph nodes, lungs, bones or liver. Both stage 1 and stage 2 prostate cancer are considered to be low risk. Usually watchful waiting or active surveillance is considered at this time. This is because early stage prostate cancer is considered to be low-risk and unlikely to grow or spread for several years. In fact the cancer grows at such a slow pace that it may never cause any problems during a man’s lifetime. During this time the physician simply monitors the patient to make sure there are no changes in the cancer. It is important that the stage of prostate cancer be accurately identified so appropriate treatment can begin if the cancer has spread.

There are many treatments available for men suffering with prostate cancer. Each type of treatment has benefits and risks. Also, other conditions such as age, overall health, heart problems, diabetes or other illnesses may affect your treatment options.

Radiation Therapy involves the use of high doses of radiation energy to treat cancer. There are different types of radiation therapy as follows:

External beam radiation involves the use of a machine which aims radiation at the cancer. The machine moves around your body, sending radiation from many directions.

3-D conformal radiation therapy is a type of external beam radiation. This process allows doctors to carefully plan the shape of the radiation beam so that it targets the cancer in a more precise manner with the intent of avoiding nearby healthy tissues.

Brachytherapy is a type of internal radiation therapy whereby the physician places radioactive material inside the prostate. The two main types of brachytherapy used for prostate cancer are low-dose rate (also called (LDR) and high-dose rate (also called (HDR.

LDR brachytherapy involves the use of seed implants throughout your prostate. The number of seeds will depend upon the size of the prostate. One implanted the radiation begins to get weaker each day and eventually runs out in from two to ten months. Once the radiation is gone, the seeds will remain in your prostate. However, they should not cause you any problems. HDR brachytherapy involves the use of tiny catheters (hollow tubes) placed throughout your prostate. The catheters will remain in place for the entire course of the treatment. However, once you have received all of your treatments, the catheters will be removed.

There are side effects with both LDR brachytherapy and HDR brachytherapy. They can include urinary problems, rectal problems and erectile dysfunction. Side effects may only last a few months after the therapy. However, they could be long lasting and possibly even permanent.

canstockphoto8527716prostatechart (420)

External beam radiation therapy and brachytherapy can be used together. Surgery is often chosen to remove the prostate gland when the cancer is thought to be local and has not spread beyond the prostate gland. Typically this applies to stage 1 or stage 2 prostate cancer.

Abdominal surgery was the standard type of surgery done to remove the prostate gland prior to the advent of laparoscopic and robotic techniques. Today, the two primary types of prostate surgery are known as radical prostatectomy or robotic –assisted laparoscopic radical prostatectomy.

Radical prostatectomy is a major surgical procedure performed under general anesthesia in a hospital. The procedure typically takes two hours or possibly longer. The urologist removes the prostate gland, the seminal vesicles and all surrounding cancer. Although, there are different methods to perform radical prostatectomy all of the methods do the same thing. During this procedure the surgeon will try to preserve the sex nerves depending upon the extent of the cancer.

A new approach is a robotic-assisted laparoscopic radical prostatectomy (RALRP). This is a technique where the surgeon sitting nearby uses a robotic interface (called the da Vinci system) to perform the surgery. Currently, this is the most common method of prostate surgery.

There are risks with any type of surgery. Risks depend in part upon your overall health, your age and the skill of the surgical team. The risks from prostate surgery include:

1. Risk from anesthesia
2. Risk of a heart attack
3. Risk of a stroke
4. Blood clot in the legs
5. Death
6. Infections in the abdomen
7. Infection at the site of the incision
8. Risk of bleeding and requiring a blood transfusion

The major side effects of radical prostatectomy are urinary incontinence (the inability to control urine) and impotence (the inability to have erections). However, these side effects can occur with either surgical or non-surgical treatments for prostate cancer.

If you are suffering with prostate cancer you should do your research before choosing any particular method of treatment. You should also discuss your treatment options and the recovery expectations with your surgeon and your family. Doing so will enable you to make the best possible decision for yourself.