Choosing the Best Treatment for You
Everybody is different and everybody's cancer is different. The method that you and your physician decide upon to treat your prostate cancer usually will depend on your stage of cancer and some other factors .Staging is explained in more detail in the diagnosis section of this site and will be used to determine what treatment options suites you. Regarding the different stages of prostate cancer the doctor determines of your cancer is either:
- Localized to the prostate only. There is cancerous cells only in the prostate tissue and has not spread to any surrounding organs such as the seminal vesicles.
- Locally advanced where the cancer has spread outside of the prostate but is still in the same general area of the prostate.
- metastatic where the disease has spread to other organs proximal or distal to the area of the prostate. The first place that prostate cancer usually will spread to is the bone.
After the stage of your disease has been determined your doctor will use this information on the stage and also consider the potential side effects each treatment type will pose to you. The doctor will also consider the benefits of each treatment to come to a final decision. Being an informed patient at this point is extremely important. This is your body and you should play an active role in the decision making process with your physician on which treatment you will receive. Have a list of questions ready and do not hesitate to stop when you do not understand something being said and ask your physician to review everything with you until you are thoroughly informed.
There are four standard treatment options available for the treatment of Prostate Cancer:
Watchful Waiting
Watchful waiting is where your condition will be closely monitored by your physician without any actual treatment taking place. Your physician will watch for changes in your symptoms or for new symptoms to arise. Since prostate cancer is a very slow growing cancer this option is often recommended in older individuals who are not candidates for surgery and have a very early stage of prostate cancer. Sometimes new symptoms never arise and the patients lives the rest of his life and dies from other causes. It is often said that most men die with prostate cancer and not of it.
Surgery
Surgery is often offered as a treatment to patients who are under 70 years old and are in overall good health. Since general anesthesia will be used during this procedure complications can arise so you have to be in good health as with any type of surgical procedure.
The most common surgical procedure used to treat prostate cancer is the radical prostatectomy. This involves the complete removal of the prostate, seminal vesicles and the surrounding tissue. There are two different ways this procedure can be done:
- Retro pubic prostatectomy: A surgical procedure to remove the prostate through an incision in the abdominal wall. Removal of nearby lymph nodes is often done at the same time.
- Perineal prostatectomy: A surgical procedure to remove the prostate through an incision that is made in the area between the scrotum and anus. Nearby lymph nodes may also be removed through a separate incision in the abdomen.
The upside to having surgery is after the prostate and tumor is removed you are almost 100% of the time cancer free. So it is the most definite treatment option. The downside as with all surgeries is side effects and complications that can arise during and after surgery.
Radiation Therapy
Treating prostate cancer with radiation therapy involves using high energy X-rays or other types of radiation to eliminate cancer cells. Two forms of radiation therapy are used to treat prostate cancer:
- EBRT (external beam radiation therapy) - uses a LINAC (linear accelerator) to produce high energy x-rays which are aimed at the tumor from outside of the body. This form of radiation therapy is non-invasive and requires the patient to come 5 days a week for approximately 8-10 weeks of treatment. Side effects from this type of treatment include frequent urination, difficulty urinating, diarrhea, and general tiredness from the radiation.
- Prostate Seed Implants (brachytherapy) - this type of treatment is given internally by using a surgical procedure to implants radioactive seeds directly into the prostate and next to or in contact with the tumor. This procedure takes a few hours and is a full surgical procedure which will require general anesthesia. After the surgery the seeds will still be radioactive until their half lives are reached. This means the patient will have to keep their distance from young growing children and pregnant woman for a specified amount of time. The amount of time depends on what types of seeds where used but is usually around 3 to 6 months.
Hormone Therapy
For prostate cancer treatment we give the patient hormones that will suppress the male hormones (andrones) in their body. Androgens (male hormones) are produced mainly in the testicles. Sometimes androgens will stimulate the growth of prostate cancer and speed up the growth of the cancer cells. If the levels of the androgens is lowered then the cancer will grow much slower and possibly shrink. Hormone therapy is not meant to cure the cancer in the prostate but if used in conjunction with other therapy such as radiation or surgery if their is a risk of recurrence.
Other Treatments:
Cryosurgery
Cryosurgery is also know as cryotherapym cryoabalation or cryosurgical abalation. Cryosurgery is where the prostate gland is frozen. By freezing the prostate gland the abnormal cancer cells will be killed. Liqiud nitrogen is used to get the prostate to the temperature needed to erradicate the cancer cells. Cryosurgery is an effective treatment for some types of cancer and has been used in early stage prostate cancer that has not spread beyonf the prostate gland. The long term outcomes of cryosurgery are not known because this is a fairly new procedure.
Cryosurgery is only effective for small tumors and the prostate must no exceed a certain volume for the patient to be a candidate for this type of treatment. The advantages of cryosurgery are the procedure can be performed many times and it can be used on patients who cannot undergo surgery or recieve radiation because of their age or overall health.
Chemotherapy
Chemotherapy is used to treat cancer by the administration of cancer killing drugs. The chemotherapy drugs stop the growth of the cancer cells by killing the cancerous cells and preventing the cancerous cells from dividing. Chemotherapy can be administered either orally (by the mouth) or injected into the veins or muscles. After the chemotherapy drugs are administered to the patient they travel through the bloodstream and their effects can be seen throughout the entire body. Since the chemotherapy drugs can reach and eliminate cancer cells in all parts of the body chemotherapy is considered a systematic treatment and is often used for high risk or advanced cancers which have a higher tendency to spread or recur. Chemotherapy can also be injected directly into the spinal cord or organ that is effected by the cancer and if this is the case the cancer killing drugs mainly effect the cancerous cells in those areas. This type of chemotherapy treatment is referred to as regional chemotherapy. The type of chemotherapy that is administered is dependent on the stage and grade of the cancer.
It is often been the belief that chemotherapy is not a treatment option for prostate cancer. For prostate cancer chemotherapy is used in clinical trails to treat advanced stage prostate cancer.
Treatment Option Decision Tools on the Web :
Listed below are websites that provide important decision making tools on prostate cancer:
click here -> NCCN Treatment Guidelines for Patients, with Decision Trees
click here -> The Institute for Clinical Research Prostate Calculator