Dear Doc | Are there non-surgical options for treating prostate cancer
Q Dear Doc, I liked how you explained the fibroid treatment last week. Well, there has been a lot of talk about prostate cancer and I was recently diagnosed with it, but all they keep talking about is surgery. Fibroids have other treatment options besides. Can my prostate cancer be treated with something other than surgery? And will surgery affect my sex life and me being able to have children in the future?
A That is a very good question. However, I cannot simply say yes or no, because the treatment will depend on the stage of your disease, meaning, how bad it is.
Prostate cancer is divided into stages based on it's severity, and it is these stages that determine how it is treated. Your doctor should already have shared with you what stage you are, and if not, it would help you to find out.
Stage I to II (localised) prostate cancer
This refers to localised disease, meaning the cancer has not spread outside of the prostate gland. There are four possible ways to treat this stage of prostate cancer. The best treatment options will depend on your age, if you are otherwise healthy, or have other ailments, the stage of your cancer, and your preferences.
Radical prostatectomy is a surgery done to remove the prostate gland and then reconnect the urethra (the tube that drains urine from the bladder) and the bladder close.
The most common complications of prostatectomy are:
- Urinary incontinence (leakage of urine)
- Erectile dysfunction (difficulty having an erection)
There are two ways in which to perform this surgery; an open and a robotic method.
The open method performs surgery through an up-and-down cut that is about three to four inches long, beginning from the top of the pubic bone going towards the navel.
The robotic method (commonly called keyhole surgery) is done through several small cuts. Small instruments and a camera are placed through these small cuts, and the surgeon operates with these tiny instruments through the small cuts, while looking at a screen, which displays what is seen happening inside through the camera.
The likelihood of reducing complications does not depend on whether the surgery is done with the open method or with a robot. Talk to your surgeon about the potential risks and benefits of the different types of prostatectomy to determine which is right for you.
Radiation therapy (RT)
There are two forms of RT used to treat prostate cancer - external beam radiation and brachytherapy.
External beam radiation, uses a machine that moves around you, directing X-rays at the pelvis. It is typically done for five days per week, for four to eight weeks. Each treatment takes just a few minutes, and you can usually continue your normal activities during treatment. This form of radiation therapy is sometimes used in combination with androgen deprivation therapy, ADT.
Possible side effects of external beam radiation include needing to run to the bathroom frequently to urinate, bladder pain, erectile dysfunction, and swelling and pain in the rectum (called proctitis). These symptoms are usually temporary.
Brachytherapy involves a doctor placing a radioactive source directly into the prostate gland. This is done under anesthesia.
One type of brachytherapy involves placing rice-sized seeds, which emit radiation into the prostate. The seeds gradually lose their radioactivity over time and are not removed. This is done as an outpatient procedure and does not require a hospital stay.
Another type, which is used less frequently, involves temporarily implanting a radioactive source into the prostate gland, then removing it after one or two days. This treatment requires that you stay in the hospital for the one- to two-day period and is usually combined with external beam radiation.
Men who undergo brachytherapy usually develop side effects which include needing to rush to the bathroom to urinate frequently, burning with urination, and occasionally, not being able to empty the bladder completely. Some men also experience erectile dysfunction. These problems are usually resolved within a few weeks to months.
Some men choose to delay prostate cancer treatment, and watch and see what happens, a strategy called active surveillance. During active surveillance, you may require additional prostate biopsies, and being monitored carefully for signs of cancer growth with an exam and blood tests every three to six months. This, however, is temporary and your doctor may recommend that you begin treatment if the cancer begins to grow. This is an option if your cancer is very small and unlikely to grow quickly. It is not recommended if you have a high-grade tumour or if your tumour has other features that suggest it is likely to behave aggressively, making it hard to cure later.
Androgen deprivation therapy
Male hormones (androgens) fuel the growth of prostate cancer. Androgen deprivation therapy, decreases the body's levels of androgens, which, in turn, decreases the size and slows the growth of prostate cancer. ADT can be done by taking medications or by having surgery to remove the testicles.
Medication therapy involves periodic injections, or a device implanted under the skin, that provide sustained delivery of medication.
Removal of the testicles may be necessary in select situations in which testosterone levels must be reduced rapidly. If you have your testicles removed, you can have artificial (prosthetic) testicles implanted to preserve a normal appearance.
Stage II (locally advanced) prostate cancer treatment
For more advanced prostate cancer which has spread to areas outside the prostate gland it is called locally advanced disease. There is no one best treatment option for this stage of disease, and treatment often takes the form of a combination of radiation therapy with ADT, and surgery (radical prostatectomy).
You will need to discuss with your doctor the stage of your disease and then chose the option that is best for you.