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Prostate Cancer: Latest Treatments and Emerging Therapies

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What are the options for early stage prostate cancer? continued...

Chemotherapy plays only a limited role in prostate cancer treatment. It's reserved primarily for the treatment of men with advanced or recurrent prostate cancer that does not respond to hormone therapy.

Your choice of surgery, radiation, or expectant management may depend on several factors:

  • Your age and life expectancy
  • Other serious health problems you may have, such as heart disease
  • Your personal preference, informed by your doctor's opinion, about whether to begin treatment or to wait
  • Your concerns about the side effects common with prostate cancer therapies

Side effects may include things that affect your lifestyle. For example, erectile dysfunction and incontinence, or urine leakage, are both possible side effects.

What's involved with surgery for early-stage prostate cancer?

If the tumor is entirely contained within the prostate, a skilled surgeon can remove the entire gland. The procedure is known as a radical prostatectomy. Prostatectomy may be a good option for younger men -- men in their 40s, 50s, and 60s -- who are otherwise in general good health. That's because these men may be more likely to die from prostate cancer than men in their 70s, 80s, or 90s.

Before a radical prostatectomy is done, doctors need to ensure the disease is contained within the prostate gland. It's possible it may have spread to nearby lymph nodes. If so, that signals the likelihood of more extensive disease that is less likely to be cured by surgery.

To make sure cancer hasn't spread, surgeons perform a pelvic lymphadenectomy (removing lymph nodes in the region of the prostate gland where cancer cells are likely to have spread, if at all). The nodes are then examined rapidly by a pathologist who looks for evidence of cancer cells. If the pathologist sees cancer cells under the microscope, surgeons generally will not perform a radical prostatectomy. They may instead refer the patient for other forms of treatment.

In a radical prostatectomy, the prostate gland and the seminal vesicles are completely removed. The seminal vesicles are small glands that contribute fluid to semen. Surgeons have several options for getting to the prostate:

  • The first is a retropubic prostatectomy. The surgeon makes an incision in the wall of the abdomen to reach the prostate. While operating, the surgeon can also remove nearby lymph nodes. This is a precautionary measure that may help prevent the spread of disease.
  • The second option is called perineal prostatectomy. The surgeon makes an incision in the perineum. That's the area between the scrotum and the anus. With this surgery, an extra incision in the abdomen is needed to remove lymph nodes.
  • In some hospitals, surgeons may do a laparoscopic or "keyhole" prostatectomy. The surgeon uses instruments that are passed through a few small incisions. This option is generally associated with fewer complications and faster recovery. But it is technically challenging and may not be appropriate for taking out all tumor types.
  • Some centers today offer surgery for prostate cancer using robotic techniques in which a surgeon directs equipment referred to as a robotic operating system to perform the procedure. In experienced hands, this technique may reduce complication rates and shorten hospital stays.
  • Some men may undergo transurethral resection of the prostate, or TURP. This is a type of surgery that is also used to treat benign enlargement of the prostate. The surgeon inserts a small surgical instrument into the urethra. That's the tube that carries urine from the bladder to the penis. Then the surgeon removes prostate tissue that causes problems such as difficult or painful urination. The surgery does not, though, remove the entire prostate gland. The process is sometimes used to relieve prostate cancer symptoms in older men. That's because these men may not be suitable candidates for a radical prostatectomy.
  • Some treatment centers also perform cryosurgery. This is a technique in which prostate tissue is destroyed by alternate freezing and thawing. The experience with this type of surgery for prostate cancer is limited. So it's not yet clear whether it offers any advantages over conventional surgery or radiation therapy.

Whenever possible, surgeons may use “nerve-sparing technique” to lessen the risk of postoperative long-term impotence. Not all urologic surgeons are trained in this and should be asked about it before surgery. When it is not possible to spare nerves in the area of the prostate and still get the cancer out, generally the nerves should be sacrificed to offer the best chance of cure.

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