Prostate Cancer Treatment Options

Treatment for prostate cancer has traditionally been surgery, in which the prostate is removed in whole or in part, and radiation therapy, in which radioactive emissions are used to burn cancer cells. For decades, these were the only effective procedures that were able to eliminate prostate cancer.

In the last decade, new treatments have emerged thanks to research conducted around the world. Most of them involve some surgical procedure to be performed even when tissue removal is not required.

Surgical options

All treatment options that involve surgery require an overnight stay in the hospital at least the night before the procedure. Some surgical options may require a hospital stay of one or more days, depending on the procedure and how quickly you recover.

A prostatectomy is a surgical procedure in which the entire prostate gland is removed. This is frequently prescribed for patients with limited prostate cancer. Along with the prostate gland, the seminal vesicles that carry sperm to the urethra, part of the bladder neck, and lymph nodes are also removed.

As a result of the removal of these organs, impotence is a common side effect along with mild to severe urinary incontinence. Also, recovery times can be slow.

A pelvic lymph node dissection is the removal of only the lymph nodes attached to the prostate gland. Lymph nodes wrap around the urethra on both sides of the prostate. The muscle tissue of the lymph nodes allows you to regulate the flow of urine through the urethra.

Lymph node removal can lead to mild to moderate urinary incontinence in many patients.

A transurethral resection is a less invasive procedure. It is done to remove or relieve obstructions in the urethra. A surgical cutting or cautery tool is inserted through the penis and sections of an oversized prostate are cut or burned.

The side effects of this surgery can cause mild to moderate urinary incontinence.

Radiotherapy

All radiation therapy treatments work on the principle that radioactive emissions burn cancer cells to kill them and prevent further growth.

External beam radiation therapy, or EBRT, uses high-energy radioactive particles aimed at the pelvis from a device outside the body. When the particles hit cancer cells, they heat up and burn quickly. This procedure is carried out for 5 consecutive days for approximately 5 to 7 consecutive weeks. No anesthesia is required and is usually done on an outpatient basis.

The complications that can arise are the following.

• Marked inflammation of the rectum or bladder or both.
• Impotence that begins up to 12 months after treatment.
• Radiation burns the sphincter or intestine.

A similar, though slightly different therapy is proton beam therapy. While still using the external source for the beam, the bean is made up of charged ions rather than radioactivity. The principle of burning cancer cells remains the same. Proton beam therapy practitioners claim a lower risk of side effects than traditional radiation therapy, although clinical studies have yet to show this conclusively.

High intensity focused ultrasound

HIFU – This is a newer treatment that is neither surgical nor invasive. It has been available in Europe for over a decade and was approved by Health Canada in 2003. Not currently available in the US With HIFU for prostate cancer, the patient undergoes a 2-3 hour outpatient procedure in which ultrasound waves focused with millimeter precision are used to kill cancerous tissue.