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Understanding Prostate Cancer -- Diagnosis & Treatment

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What Are the Treatments for Prostate Cancer? continued...

Watchful Waiting

Since prostate cancer can grow slowly and may not be fatal in many men, some patients -- after discussing the options with their doctors -- opt for "watchful waiting." Watchful waiting means not treating it. Instead, the doctor regularly checks the prostate cancer for signs that it is becoming more aggressive. Watchful waiting recommended for men who are older or have other life-threatening conditions. In these cases, a less aggressive cancer may be growing so slowly that it's not likely to be fatal.

Surgery

The standard operation, a radical retropubic prostatectomy, removes the prostate and nearby lymph nodes. In most cases, surgeons can remove the gland without cutting nerves that control erections or the bladder, making impotence or incontinence much less common than in the past. Depending on the man's age and the amount of surgery needed to remove all the cancer, nerve-sparing operations allow about 40%-65% of men who were able to get erections before surgery to be able to do so after surgery without the need for erectile dysfunction treatments.

Laparoscopic robotic prostatectomy is a surgery using a laparoscope aided by robotic arms. This operation is now the most popular form of radical prostatectomy in the United States.

After surgery, most men have temporary urine leakage, called incontinence, but they usually regain complete urinary control over time. If it is severe or lasts a long time, incontinence can be managed with special disposable underwear, exercises, condom catheters, biofeedback, penile clamps, implants around the urethra, or a urethral sling.

After surgery or radiation, men may have impotence. Treatment for this side effect includes drugs such as Viagra, Levitra, and Cialis. Other treatments include teaching the man to perform a painless self-injection into the penis (of a drug called Caverject), or vacuum pumps. These treatments work in 15% to 40% cases of impotence after surgery and 50% to 75% cases of impotence after radiation. A penile prosthesis is only used when all other options have failed. 

Radiation

Radiation is often the main treatment for prostate cancer that has not spread. It may also be given as follow-up to surgery. Radiation may also be used, in advanced cases, to relieve pain from the spread of cancer to bones. Incontinence and impotence also occur with radiation. Radiation to the pelvis may also be done if PSA levels rise after surgery.

An advanced form of radiation, known as intensity modulated radiation therapy (IMRT), can increase the dose of radiation to the prostate with fewer side effects to the surrounding tissues. Proton beam therapy can increase the radiation dose to the prostate even more. But proton therapy is controversial as it has not been proven to be superior to IMRT.  A more focused form of radiation, known as stereotactic radiation, is being used for early forms of prostate cancer. This treatment also has not been shown to improve the outcome of prostate cancer. Stereotactic radiation for prostate cancer is still new.

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