Prostate cancer is the number one cancer affecting men in North America. The number one risk factor is age. Prostate cancer is rare in men under 50, whereas 80% of men over 80 contract the disease. The earlier you detect and get treatment, the better the cure rate. There are alternative treatments to the traditional options of surgery and radiation. All treatments carry the risk of side effects, with some more significant than others. Know your options, including newer treatments with fewer significant side effects.
Surgery and external beam radiation therapy are the most common treatments for men with prostate cancer.
Surgery is invasive and requires a hospital stay. The surgical options are a prostatectomy where your entire prostate is removed, a pelvic lymph node dissection where only the lymph nodes are removed or a transurethral resection. The transurethral resection involves the removal of sections of the prostate through the urethra.
Side effects from surgical procedures typically are impotence and moderate to severe urinary incontinence.
External beam radiation therapy or EBRT employs a radioactive source focused on your pelvic region to burn away diseased cells. While no overnight hospital stay is required, it is carried out over a period of about 5 weeks. You would receive this treatment on 5 consecutive days for 5 consecutive weeks on an out-patient basis. Side effects include impotence and a condition caused by holes being burned between the rectum and the prostate.
The range of treatments for prostate cancer today has expanded greatly in the past few decades.
Brachytherapy uses the advantages of radiotherapy but limits the amount of tissue exposed by implanting radioactive pellets directly into the prostate. This procedure takes up to 3 hours. In that time the pellets are implanted with a series of about 40 injections. Because the effective range of the radioactive source is small, the amount of tissue affected can be tightly controlled. Cancerous cells are radiated by these small sources and destroyed. This procedure is effective but the cancer may return as it has in studied cases.
Cryotherapy uses cold to destroy cancer cells. While you are put under general anesthetic, your prostate gland is frozen and then thawed. The radical changes in temperature serve to kill the cells in your prostate, thereby destroying the cancer. While freezing the gland has been proven effective, side effects like urinary incontinence, impotence and severe pain in the pelvic area can result.
Hormone therapy is typically prescribed in cancers that are incurable. The object of hormone therapy is to alter your testosterone levels and slow the growth of the tumors. Unfortunately, most patients develop a resistance to the effects of the hormone treatments after about 2 years and so is a temporary measure.
Chemotherapy is often used after that to relieve pain and control the growth of a tumor to improve your quality of life. Again, it is not a cure.
This treatment uses focused sound waves to heat and destroy diseased cells in the prostate. Where the nerve entering the prostate is cancer free, patients receiving HIFU treatments report impotence or sexual dysfunction only 20% of the time; where the nerve is affected by the cancer, impotence results in about 40% of patients treated.
Other side effects reported are mild urinary incontinence in 8% of patients, total urinary incontinence in 1% and a narrowing of the urethra in 8% of patients.
After treatment, patients report a temporary narrowing of the urethra lasting a few months, diminished sexual activity for a number of weeks afterward and temporary impotence for up to 12 months.