Treatment Options for Prostate Cancer
It’s only natural when handed a diagnosis of cancer that your mind jumps to potential treatment options. But, in the case of prostate cancer, treatment isn’t always the next best move.
Prostate cancer is really a spectrum of diseases. Not every diagnosis warrants aggressive treatment, or even any treatment at all.
Most prostate cancers grow very slowly. By the time a cancer shows up on a screening test, it’s likely a person has been living with it for months, or even years with no symptoms or ill-effects. It’s likely they can live many more years with it before symptoms develop or it becomes necessary to treat it.
When a person is diagnosed with prostate cancer, the first thing their provider will want to determine is how aggressively it is likely to grow and spread. There are a few risk factors she or he will look at to quantify the level of risk involved, such as the stage, the Gleason score (a measure of how abnormal the cancer cells look microscopically on a biopsy), and the level of prostate-specific antigen, or PSA, in the blood. If it is deemed to be of low risk, the best course may be to keep a careful watch on it in the hope that treatment can be delayed or never become necessary at all.
This strategy used to be called ‘watchful waiting’ until the medical community campaigned to change the term to ‘active surveillance.’ We did so to emphasize that we aren’t just standing idly by and doing nothing; we are actively monitoring for any change in the circumstances, with every intention of intervening if something in the overall situation changes or looks more worrisome.
In cases where treatment is deemed necessary, most patients are offered one of two options: surgery or radiation.
Treatment recommendations are always personalized to the individual patient, but, for most patients, surgery and radiation are equally effective options. Likewise, the risk of running into side effects or complications for each treatment approach is about the same, though the side effects themselves are different. The decision as to which treatment to pursue should be weighed carefully and with consideration given to which side effects the patient finds more acceptable, the convenience and logistics of each type of treatment, and personal preference.
If you’re trying to decide on a treatment option, talk to your doctor about how they compare.
Treatment Options for Prostate Cancer: Surgery vs Radiation
Benefit: The cancer is extracted by removing as much of the prostate as possible. You should experience fewer gastrointestinal problems than if you have radiation.
Treatment requirements: Surgery takes about 2 to 4 hours and requires an overnight hospital stay.
Potential side effects and downsides:
• As with any major surgery, there is some risk of pain, bleeding, and infection.
• Use of a catheter may be required for 1 to 2 weeks after surgery.
• You may experience incontinence, or uncontrolled leakage of urine for several weeks aft er surgery. For about 10-15% of men, incontinence may be permanent.
• You may experience trouble getting an erection after surgery.
Benefit: Does not require you to be put under for surgery or to stay overnight at the hospital. You may experience fewer problems with urination than if you have surgery.
Treatment requirements: Your cancer is painlessly treated with radiation once a day, 5 days a week, for typically between 6 and 9 weeks (28 to 44 individual treatments, depending on risk factors). There are other, shorter treatment schemes that may be appropriate in select cases.
Potential side effects and downsides:
• You may experience more frequent and softer bowel movements.
• Your urge to urinate may be stronger and more frequent.
• Many patients also need medication to suppress the production of testosterone. That medication may also produce side effects.
• You may develop erectile dysfunction within 5 years of treatment.
• Some patients can develop bleeding in the urine or stool.
• Radiation can (very rarely) cause a new cancer to form many years after treatment.
Matthew Vernon, MD, is a Radiation Oncologist Southwestern Vermont Regional Cancer Center.