Prostate Cancer: Latest Treatments and Emerging Therapies
What are the complications and side effects of surgery for early-stage prostate cancer?
There is a bundle of delicate, easily damaged nerves that runs through or near the prostate. Even the most skilled and careful surgeon may not be able to avoid complications. One possible complication is erectile dysfunction. Some surgeons use a nerve-sparing technique. There is, though, no guarantee that erectile dysfunction will not occur. And nerve-sparing surgery may not be an option for men with tumors that lie close to the nerves. It also may not be an option for men with large tumors.
Erectile dysfunction after prostate cancer surgery tends to improve over time. About half of all men whose nerves were left intact during surgery recover normal erectile function after one year. And three-fourths recover normal function after two years. Studies have shown that drugs such as Viagra, Cialis, and Levitra can help men who have erectile dysfunction after nerve-sparing surgery. But these drugs are less effective if there is significant damage to the nerves.
Other common complications of radical prostatectomy include urinary incontinence -- the involuntary leakage of urine from the bladder -- and fecal incontinence, the involuntary leakage of stool from the rectum. These complications may get better over time. They may even completely disappear. But some men continue to have problems indefinitely. About 25% of men have urine leakage after surgery and need to use absorbent pads or disposable absorbent underwear for up to six months after surgery. But after two years, less than 10% need absorbent pads. In severe cases, some men may need surgery to support the sphincter muscles that control the release of urine.
What's involved with radiation for early-stage prostate cancer?
There are two basic types of radiation therapy: external beam radiation, and brachytherapy or "tumor seed treatment."
In external beam radiation, the prostate is exposed to high energy X-rays from a machine outside the body. The process is repeated over multiple treatment sessions. In brachytherapy, small radioactive pellets or "seeds" are placed in or near the tumor. Radiation can also be delivered to the prostate with the use of needles, wires, or thin tubes called catheters.
Proton beam therapy is a type of external radiation therapy. It involves the use of a tightly focused beam of protons. These are atomic particles with a positive electric charge. The advantage of this type of therapy is that the beam delivers most of its energy to the target tissue. That spares surrounding, healthy tissues from large doses of radiation. This type of therapy is more expensive than the non-proton radiation techniques in common use. It's offered in only a few treatment centers in the United States and may not be covered by insurance. Right now, there is no clear evidence from patient studies that suggests that proton beam therapy is better than standard radiation techniques though there is a definite theoretical advantage for proton therapy.