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Exploring Your Treatment Options for Prostate Cancer


Prostate Cancer Image

Men with prostate cancer have many treatment options. These options include active surveillance, surgery, radiation therapy, hormone therapy, chemotherapy, and immunotherapy. You may receive more than one type of treatment.

The treatment that’s best for one man may not be best for another. The treatment that’s right for you depends mainly on your age, Gleason score (grade) of the tumor, stage of prostate cancer, your symptoms, and your general health. At any stage of disease, you can talk with your healthcare team about ways to manage pain and other symptoms, relieve the side effects of treatment, and ease emotional concerns.

Active Surveillance
Your doctor may suggest active surveillance if you’re diagnosed with early-stage prostate cancer that seems to be growing slowly. Your doctor may also offer this option if you are older or have other health problems.

Active surveillance is putting off treatment until test results show that your prostate cancer is growing or changing. If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly. You’ll get digital rectal exams and PSA tests. After about a year, your doctor may order another prostate biopsy to check the Gleason score. Your doctor may suggest treatment if your Gleason score rises, your PSA level starts to increase, or you develop symptoms.

If you choose active surveillance but grow concerned later, remember that you can change your mind and begin treatment at any time.

Surgery
This is an option for men with early-stage cancer that is found only in the prostate. It’s sometimes also an option for men with advanced prostate cancer to relieve symptoms.

If you choose active surveillance but grow concerned later, remember that you can change your mind and begin treatment at any time.

There are several kinds of surgery to treat prostate cancer. Usually, the surgeon will remove the entire prostate and nearby lymph nodes. Your surgeon can describe each kind of surgery, compare the benefits and risks, and help you decide which kind might be best for you. The entire prostate can be removed in several ways:

♦ Through a large cut in the abdomen
The surgeon removes the prostate through a long incision in the abdomen below the belly button. This is called a radical retropubic prostatectomy. Because of the long incision, it’s also called an open prostatectomy.

♦ Through small cuts in the abdomen
The surgeon makes several small cuts in the abdomen, and surgery tools are inserted through the small cuts. A long, thin tube (a laparoscope) with a light and a camera on the end helps the surgeon see the prostate while removing it. This is called a laparoscopic prostatectomy.

♦ With a robot
The surgeon may use a robot to remove the prostate through small incisions in the abdomen. The surgeon uses handles below a computer display to control the robot’s arms.

♦ Through a large cut between the scrotum and anus
The surgeon removes the prostate through an incision between the scrotum and anus. This is called a radical perineal prostatectomy. It’s a type of open prostatectomy that is rarely used anymore.

Other surgery options for treating prostate cancer or relieving its symptoms include

♦ Freezing
For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue.

♦ Heating
Doctors are testing high-intensity focused ultrasound therapy in men with prostate cancer. A probe is placed in the rectum. The probe gives off high-intensity ultrasound waves that heat up and kill the prostate tumor.

♦ TURP
A man with advanced prostate cancer may choose transurethral resection of the prostate (TURP) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

The time it takes to heal after surgery is different for each man and depends on the type of surgery. You may be in the hospital for one to three days. After surgery, a tube will be inserted into your penis to allow urine to drain from your bladder while the urethra is healing from the surgery. You’ll have the tube for five to fourteen days. Your nurse or doctor will show you how to care for it.

Some men may lose control of the flow of urine (urinary incontinence) after surgery. Most men regain at least some bladder control after a few weeks. Your nurse or doctor can teach you an exercise to help you recover control of your bladder. For some men, however, incontinence may be permanent. Your healthcare team can show you ways to cope with this problem.

Surgery may also damage nerves near the prostate and cause erectile dysfunction. Sexual function usually improves over several months, but for some men, this problem can be permanent. Talk with your doctor about medicine and other ways to help manage the sexual side effects of prostate cancer treatment.

If your prostate is removed, you’ll have dry orgasms, which means you’ll no longer release semen. If you wish to father children, you may consider sperm banking before surgery.

Radiation Therapy
This type of treatment is an option for men with any stage of prostate cancer. Men with early-stage prostate cancer may choose radiation therapy instead of surgery. It may also be used after surgery to destroy any remaining cancer cells in the area. In men with advanced prostate cancer, radiation therapy may be used to help relieve pain.

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

♦ External radiation therapy
The radiation comes from a large machine outside the body. Computers may be used to more closely target the prostate cancer. For example, intensity-modulated radiation therapy, proton radiation therapy, and three-dimensional conformal radiation therapy are types of radiation therapy that use computers to lessen damage to healthy tissue. Treatments are usually five days a week for eight to nine weeks. Each treatment session lasts only a few minutes.

♦ Internal radiation therapy, or brachytherapy
Two methods of internal radiation therapy are used for men with prostate cancer. One method places dozens of radioactive seeds inside needles, and the needles are inserted into the prostate. When the needles are removed, the seeds are left behind. The seeds give off radiation for a few weeks or months. They don’t need to be removed once the radiation is gone, and you won’t need to stay in the hospital for treatment.

Another method involves inserting several tubes into the prostate. Radioactive material is loaded into the tubes. The treatment session lasts for a few minutes, and the radioactive material is removed. This treatment may be repeated as many as five times. You’ll stay in the hospital for one or two days, and then the tubes will be removed. When you leave the hospital, no radioactivity remains in your body.

Side effects depend mainly on the type of radiation therapy you receive and how much radiation is given. You’re likely to become tired during external radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga.

Radiation therapy can also harm the skin. During external radiation therapy, it’s common for the skin in the treated area to become red, dry, and tender. The skin near the anus is especially sensitive. Check with your doctor before using lotion or cream on the treated area. You may lose hair in the treated area, and it may not grow back. Brachytherapy may make the area look swollen and bruised. After treatment is over, the skin will slowly heal.

You may wish to discuss with your doctor the possible long-term effects of radiation therapy for prostate cancer. Radiation may harm the penis, rectum, and bladder, and side effects may develop six months or more after treatment ends. For example, both types of radiation therapy may cause erectile dysfunction, bleeding from the rectum, diarrhea, or rectal discharge. Other possible problems include finding blood in your urine, feeling an urgent need to empty your bladder, or needing to empty your bladder more often than you used to.

Hormone Therapy
Men with advanced prostate cancer usually receive hormone therapy. In addition, a man with early-stage prostate cancer may have hormone therapy before, during, and after radiation therapy. Hormone therapy may also be used after surgery.

Hormone therapy keeps prostate cancer cells from receiving male hormones (androgens such as testosterone), which can cause prostate cancers to grow. Types of hormone therapy include

  • A drug that can prevent the testicles from making testosterone (LH-RH agonist)
  • A drug that can block the action of male hormones (antiandrogen)
  • Surgery to remove the testicles, which are the body’s main source of testosterone
  • A drug that can prevent the adrenal glands from making testosterone

The side effects of hormone therapy depend on the type used. The most common side effects are erectile dysfunction, hot flashes, and loss of sexual desire. Other possible side effects include breast growth, an increase in body fat around the waist, and an increase in sugar level in your blood. Hormone therapy can also weaken your bones. Your doctor can suggest medicines that may reduce your risk of breaking a bone.

An LH-RH agonist may make pain and other symptoms worse at first. This temporary problem is called a flare. To prevent a flare, your doctor may give you an antiandrogen for a few weeks along with the LH-RH agonist.

Chemotherapy
This type of treatment may be used for men with advanced prostate cancer. Chemotherapy uses drugs to kill cancer cells. You may receive chemotherapy in a clinic, at the doctor’s office, or at home. Men rarely need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly, such as blood cells, cells in hair roots, and the cells that line the digestive tract. Other side effects include shortness of breath and a problem with your body holding extra water. Most of these problems go away when treatment ends.

Immunotherapy
This treatment may be used for men with advanced prostate cancer who are not helped by hormone therapy. Immunotherapy stimulates the immune system to kill cancer cells. For immunotherapy for prostate cancer, a treatment is made from some of your own blood cells. You’ll receive a total of three injections of treatment. The injections are given one at a time, usually two weeks apart. This type of immunotherapy is also known as a treatment vaccine.

The most common side effects are headache, backache, fatigue, and having a fever and chills. These effects usually go away.

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For some people, taking part in a clinical trial may be the best treatment choice. For information about cancer clinical trials or to search the National Cancer Institute’s list of clinical trials now accepting participants, visit cancer.gov/clinicaltrials.

Source: National Cancer Institute, cancer.gov

This article was published in Coping® with Cancer magazine, January/February 2013.

Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.