About Prostate Cancer
Prostate cancer patients have a variety of treatment options to choose from. Each has both pros and cons. Patients and doctors should discuss the various benefits and problems associated with each treatment option to choose the best one. Finding the best treatment option requires studying a patient’s age, PSA, lifestyle, quality of life issues, and Gleason score. Currently, patients can seek the following treatments:
Many patients choose to do nothing to treat their prostate cancer. This is called watchful waiting, and it is often chosen because of the potential side effects of treatment. Each treatment is described in detail below.
(HIFU) High Intensity Focused Ultrasound
HIFU using the Sonablate® 500 uses a transrectal probe to deliver focused ultrasound waves to the prostate in an innovative, non-invasive treatment. The focal zone, the point inside the prostate gland where the ultrasound waves intersect, is heated to a high temperature quickly, destroying the tissue. This destroys or ablates the entire prostate gland, effectively eliminating the cancer. HIFU ablates the entire gland so that there is less likelihood of the cancer coming back in tissue that was left in the prostate. HIFU with the Sonablate® 500 is a procedure that takes one to three hours to perform. It does not require a hospital stay, but is performed on an outpatient basis using spinal anesthesia. There is little recovery time required. During the one to three week recovery period the patient will wear a catheter while the body heals so that the bladder can be fully emptied. Within hours of a HIFU treatment patients are able to walk, and most return to their normal lives one or two days after their treatment. HIFU using the Sonablate® 500 carries little risk of side effects like impotence and incontinence. Click here to view HIFU compared with other treatment options.
There are two treatments that fall into the radiation therapy category: External Beam Radiation Therapy (EBRT) and bracytherapy (seed implants). EBRT is used for patients whose prostate volume is less than 60 grams. This procedure requires four to six weeks of radiation therapy. The radiation is directed into the prostate from outside of the body. Brachytherapy involves transmitting radiation into the prostate through tiny radioactive “seeds,” or pellets, placed inside the gland.
While radiation therapy is nowhere near as destructive as it used to be, the procedure carries some risk because there is no precise way to control where the radiation is delivered. Also, as the radiation passes through the body to reach the prostate during EBRT, it can damage the cells it travels through. Even with seed implants, the radiation can extend past the treatment area and damage the urinary sphincter or neuro-vascular bundles surrounding the prostate. This leads to incontinence and impotence. Studies indicate that 25% of all men who have radiation therapy experience changes with their ability to attain an erection. This is often a slow change that happens during the first year after undergoing the therapy. Around one-fifth of all men treated with radiation therapy have problems with incontinence.
Another potential side effect of radiation therapy is damage to the bowels and the rectum. This happens because of the ionizing radiation damaging the tissues in this area of the body. If this causes severe proctisis or rectal fistulas, a colonoscopy may be necessary. There appears to be a correlation between radiation treatment for prostate cancer and later development of colon or rectal cancers. The radiation field may also affect the bladder, causing a condition known as radiation cystisis, which is an irritation of the bladder that is not related to any infections.
Cryptherapy is a minimally invasive procedure that uses extremely low temperatures to destroy the prostate cells. It is sometimes known as cryoablation or cryosurgery. These procedures effectively freeze the cells in the prostate using an infusion of toxic argon gas. After the argon infusion is complete, the doctor infuses helium into the gland to thaw the tissue. This is repeated twice to destroy all cancer cells. While it is considered a minimally invasive treatment option, it does require a hospital stay and longer recovery. Patients will wear a catheter for two to three weeks while they heal. Studies indicate that 10% to 30% of all patients treated with cryotherapy will be incontinent, while more than 90% will be impotent.
The goal of hormone therapy is to reduce the amount of testosterone in the body. Testosterone stimulates the growth of prostate cancer cells, so reducing its levels in the body stops the cells from growing. This appears to extend the life of the patient and slow down the progression of the cancer. However, hormone therapy is a temporary fix because prostate cancers will eventually become resistant to hormone therapy over several months of treatment. Men treated with hormone therapy sometimes experience a loss of muscle mass, weight gain, decreased mental abilities, breast growth, hot flashes, depression, decrease in good cholesterol levels, and fatigue.
Radical Prostatectomy (Open, Laparoscopic, Robotic)
A radical prostatectomy is a highly invasive surgery that removes the prostate and surrounding tissue either through laparoscopic or open surgery. Laparoscopic prostatectomy procedures can last for up to eight hours, while open surgeries are over in between two to four hours. Most patients are placed under general anesthesia and stay in the hospital for three to seven days. During the recovery, which can last up to three weeks, radical prostatectomy patients will wear a catheter. Studies indicate that 10-15% of patients undergoing this procedure have some degree of stress incontinent, while at least 50% will suffer from erectile dysfunction. Robotic surgery is using the laparoscopic approach and attaching four of the instruments /ports to a Surgical Robot that is directed by the surgeon sitting at a console. There is less bleeding than open surgery, a faster recovery and less pain. There is still a 5-10% chance of some degree of incontinence and about a 25% chance of erectile dysfunction. This approach is only offered a few hospitals across Canada.