Prostate Cancer

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Treatment Options

Brachytherapy treatment involves the placement of radioactive seeds, approximately the size of a small grain of rice into the prostate. Approximately 60 – 120 seeds are implanted through small needles into the prostate gland during this 1 hour outpatient procedure where you will be given either spinal or general anesthesia to make you completely pain free during the procedure. Your physician may request that you visit the facility a few days prior to the treatment in order to obtain current PSA scores and other data that will help in creating a treatment plan for you.

Since brachytherapy is considered a minimally invasive procedure these treatment are often given in an out-patient facility. Using ultrasound guidance or computer aided planning the seeds are placed in the prostate and arranged in a way to give off a uniform dose of radiation delivered exactly where it is needed. The seeds will remain in place after the procedure and slowly lose their radioactivity. Radiation safety precautions with palladium seeds are minimal. Contact with children and pregnant women is safe for all. It is recommended that you hold nursing age babies on your shoulder and not on your lap for the first month after the implant. Your doctor will discuss in greater detail specific precautions you should be aware of. You may return to normal activities in several days or strenuous activity may be restricted for a short period of time as you heal.

Should you choose brachytherapy for your prostate cancer treatment you should talk with a specialist regarding their particular approach to brachytherapy. The side effects for brachytherapy are lower than for other forms of treatment.

If your physician determines that your cancer is confined to the prostate gland they may recommend surgery. In a radical prostatectomy your surgeon will make a small incision or cut in order to gain access to your prostate. The prostate gland and a small amount of the surrounding tissue will be removed. You may be under general anesthesia (asleep) or you may be given medicine to numb the lower half of your body. The average hospital stay is several days and you should expect to spend 4-6 weeks away from work. After your surgery you will require a catheter for 1-3 weeks to allow you to urinate comfortably while you heal. The catheter will be removed at a follow-up appointment.

Laparoscopic radical prostatectomy also called robotic assisted prostatectomy has been gaining in popularity in some areas. The surgeon sits at a computer screen away from the patient and controls robotic arms that cut away the prostate through many small incisions or cuts. There is little difference to the patient in terms of the surgical experience however the recovery times may be slightly less. The most important factor should you choose this form of treatment is the experience of your physician using this equipment. You should understand how many procedures your physician has performed prior to agreeing to this treatment path.

With either of the above approaches you should carefully weigh the risks of surgery as a treatment option. As with all major surgical procedures, there is a risk associated with the use of anesthesia, as well as a risk of heart attack or stroke, bleeding problems or infection as a result of the surgery. The major side effects of surgical removal of the prostate are incontinence (loss of control of urination) and impotence (in ability to obtain or maintain an erection sufficient for sex). Since the nerves for bladder and sexual function run close to the prostate there is a risk of damaging one or both of these nerves. This damage is often permenant.

Two forms of radiation therapy are available for the treatment of prostate cancer, internal or external. Both forms of radiation therapy employ a form of radiation to kill the cancer or shrink the tumor that is similar to an x-ray. External radiation therapy, also referred to as EBRT (external beam radiation therapy) and IMRT (intensity modulated radiation therapy) target the cancer from outside the body. Radiation therapy may be used along or in conjunction with the surgical removal of the prostate in order to remove any potential traces of cancer from the surrounding tissue. Radiation therapy, radical prostatectomy and brachytherapy have similar cure rates for early stage prostate cancer.

If you are considering external radiation as a form of treatment for prostate cancer you may want to consider the time commitment to treatment. While each treatment only lasts for approximately five minutes, these treatments are typically given 5 days a week over the course of 7 – 9 weeks. Possible side-effects to consider are bowel problems which are present in 10% – 20% of men and tend to dissipate over time, bladder problems or the need to urinate more frequently, impotence is roughly equivalent to that of surgery, lymphedema or fluid build up in the groin and legs, and a general feeling of tired for a few months after your treatment is concluded.

Since prostate cancer can be slow growing your doctor may suggest watchful waiting as one way to manage your cancer. Typically suggested for older men or those with more complex health problems watchful waiting includes frequent visits to your physician. They may perform regular PSA tests, rectal exams, and ultrasounds to see if the cancer is growing. It is important to note that not all physicians mean the same thing when speaking of ‘watchful waiting’ so it is extremely important to have a clear discussion with your physician.

Prostate Cancer in the U.S.

Taking an active role in your treatment plan is the first step in making an informed decision about your health. There may be more than one treatment option to choose from and doctors may differ in their opinions about the best way to treat your particular cancer. You should take some time in coming to a decision about your treatment and weigh the potential outcomes with common side effects of each treatment option. Your quality of life during and after your treatment should be well considered. You should take into account the following factors when assessing each treatment option.

  • Age (and anticipated life expectancy)
  • Overall health condition
  • Treatment goals (relive symptoms and minimize side effects)
  • Ability to tolerate side effects
  • Time commitment to treatments
  • Insurance coverage or treatment costs

 

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