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Understanding Prostate Cancer -- Diagnosis & Treatment

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What Are the Treatments for Prostate Cancer?

Once the decision is made to treat prostate cancer, your doctor will decide the type of treatment. Decisions about how to treat this cancer are complex, and it makes sense for men to seek a second opinion before making a treatment decision. Treatment may include doing nothing, a single therapy, or some combination of radiation, surgery, hormone therapy, and rarely chemotherapy. The choice depends on many things. Prostate cancer that hasn’t spread usually can be cured with surgery or radiation.

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. 

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