| Prostate Cancer - Treatment options |
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Active Surveillance
Description:
Active surveillance means keeping a close eye on you medically,
to see how your prostate cancer is going to behave. You will continue
to visit your doctor regularly and remain in contact with your
Urologist or Oncologist. You may hear your doctor call this 'watching
and waiting'. Doctors carry out regular blood tests and examinations
during active
surveillance so that they can pick up any growth of the cancer
and then discuss with you when to start treatment.
Advantages:
- You may have many years free of problems from the cancer, and from the side effects of treatments
- No hospital stay and recovery period
Disadvantages:
- Some men find it very stressful knowing they have cancer and not being actively treated
- Around 30% of men on active surveillance will go on to require a radical treatment
- It is important for men to be diligent in attending medical appointments and keeping good records
Brachytherapy
Description:
Prostate Brachytherapy is also sometimes called internal
radiotherapy, implant therapy or seed implantation. The prostate
is implanted with
tiny radioactive seeds, each the size and shape of a small grain
of rice. It can be carried out under a general anaesthetic or sometimes
using a spinal anaesthetic ( epidural). There are two types of brachytherapy
- low dose rate and high dose rate. Both treat prostate cancer
with radiation from inside the prostate. But there are differences
in the way you have the treatment.
Low Dose
The treatment involves having very small radioactive 'seeds' put into your prostate. The seeds stay there and give a high dose of radiation to the prostate cancer over a few months. The radiation does not travel very far in the body. So, surrounding healthy tissue receives a much smaller dose than the prostate.
High Dose
With high dose brachytherapy, you receive all your radiation during the treatment and then the doctor removes the radioactive material straight away. There is no radioactive material left inside the prostate.
Advantages:
- Low Dose Brachytherapy is a simple procedure involving
several planning sessions and one treatment session.
- Recovery is quick
- This can usually be used without hormone treatment
- The radiation is targeted giving high doses to the prostate while minimising damage to surrounding organs
- Long term data exists to support the effectiveness of Brachytherapy.
Disadvantages:
- Can cause narrowing of the urethra (making it difficult to pass urine)
- Requires one or two general anaesthetics
- Only suitable for small prostate cancers and small prostates.
- Can take up to two years after treatment for the PSA to fall to its lowest level
- You should avoid fathering a child for two years because the radiation may harm an unborn child
- Erectile Dysfunction, in up to 50% of men
- Bowel problems in about 5% of men
- Tiredness for 4 to 6 weeks after the procedure
- Urinary Incontinence is rare in men treated with Brachytherapy,
but you may be at greater risk if you have previously had
surgery to treat urinary problems. Up to four out of ten
men who have had a major TURP operation to treat BPH (Benign
Prostatic Hyperplasia) experience stress incontinence after
Brachytherapy.
- Needles placed in the perineum can cause bruising and pain
for several days after the procedure.
Cryosurgery
Description:
Cryosurgery also known as ‘cryotherapy’ or ‘cryoablation’ is a way of killing cancer cells by freezing them. It freezes the prostate gland in order to destroy it. This is done by inserting probes into the prostate, which are then reduced to a very low temperature. Cryosurgery is suitable for those with localised prostate cancer.
Advantages:
- Relatively non-invasive
- Can sometimes be undertaken as an outpatient
- Recovery time of a few days
- Low chance of blood transfusions
- Prostate Cancer Treatment can be repeated if needed
- Can be used before or after other treatments as needed
Disadvantages:
- Short term Incontinence in 4-5% of men
- The risk of Impotence is high. Approximately 80% of men suffer (both short and long term)
- Up to 19% of men have trouble with bladder control following treatment
- Fistula – this is an unnatural join between two hollow
organs; in this case the rectum and the urethra. This occurs
due to tissue damage after freezing. It affects approximately
1%-3% of patients.
- Relatively new Prostate Cancer treatment, so little long
term effectiveness data.
- Limited number of urologists offering cryotherapy
HIFU
Description:
HIFU stands for High Intensity Focused Ultrasound. It is a treatment for localised prostate cancer. The treatment does not involve an incision and uses intersecting, precision focused ultrasound waves through the back passage to raise the temperature of the target tissue to 80-90 degrees Celsius in two to three seconds, effectively destroying the targeted cancerous tissues.
Advantages:
- No incision, therefore avoiding the risk of a surgical site infection
- Usually a day case
- It aims to preserve the vital structures around the gland therefore preserving continence, erectile and orgasmic function
- The procedure can be repeated if necessary
- Radiation therapy and surgery are still options if the procedure fails
- Over 99% of men remain continent
- Around 70% men retain erectile function
Disadvantages:
- 30-40% of patients may experience some short term urinary symptoms after the procedure due to the debris causing an obstruction in the urethra.
- Most men will be infertile due to the decreased or absent ejaculatory fluid
- It is a fairly long procedure (2 to 3 hours)
- Fistula – this is an unnatural join between two hollow
organs; in this case the rectum and the urethra. This occurs
due to tissue damage after heating. It effects approximately
1% of patients.
- 2-5% of men get a narrowing of the urethra (stricture)
- First UK treatment only 3 years ago, so lack of long term data
Hormone Therapy
Description:
Most prostate cancer cells are stimulated by testosterone, a primary male hormone. By eliminating testosterone from the body, prostate cancer cells drastically slow down their growth rates. A drop in testosterone levels can affect all prostate cancer cells--even those that have spread to other parts of the body, and can control prostate cancer for several years. Generally, hormone therapy is only selected to slow the growth or spread of prostate cancer that has already spread beyond the prostate. Men with cancer that has returned after a radical prostatectomy or radiation therapy may also be considered for hormone therapy. Urology surgeons may also use hormone treatment to reduce the prostate gland size before brachytherapy, cryotherapy, or HIFU.
Advantages:
- It is a good option if the cancer has spread outside the prostate ‘locally advanced’ or moved further in the body, ‘advanced or 'metastatic’ prostate cancer, as it works wherever the cancer is in the body.
- Hormone therapy may also be used as an additional prostate
cancer treatment before or after radiotherapy.
- If may be used if you have had a previous prostate cancer
treatment and the cancer has recurred.
Disadvantages:
Side effects of all types of hormonal therapy are similar and are the result of the reduced testosterone levels. These can include:
- Loss of libido or sex drive
- Impotence
- Hot flushes
- Breast swelling and tenderness
- Weight gain
- Tiredness
- Nausea and vomiting
- Osteoporosis may happen in the long term
Radiotherapy
Description:
Radiotherapy can be used to treat localised and locally advanced prostate cancer.
X-ray beams are directed at the prostate from outside the body. The beams damage the cells. Cancer cells are not able to recover from this damage and die, but normal healthy cells can repair themselves more easily.
Advantages:
- It is a suitable prostate
cancer treatment for men of any age
- It is as effective as surgery at treating the prostate cancer.
- It has none of the risks associated with a general anaesthetic
- You do not need to stay in hospital overnight
- You can carry on with some of your usual activities while
you are having treatment
Disadvantages:
- Painful ejaculation during treatment
- A burning feeling when urinating can follow the treatment, short term.
- A 50% risk of erectile dysfunction and infertility
- It is possible for some cancer cells to escape the radiotherapy and it is difficult to tell for up to two years whether the treatment has worked
- Tiredness from the radiation and from having treatments at hospital every day for 6 weeks
- Skin irritation and hair loss in the area that has been treated
- Radiotherapy can cause men to pass urine more often and
you may get a burning sensation (radiation cystitis). In
rare cases (around one in a hundred men) radiotherapy can
cause you to leak urine.
- The bowel and back passage are exposed to the radiation,
possibly causing diarrhoea and irritation to the back passage
which may not get better
Surgery (Radical Prostatectomy)
Description:
Surgery can be used to treat early localised prostate cancer that is contained in the prostate gland. The aim of the surgery is to take out the cancer and to stop it spreading to other parts of the body. This is done by removing the whole prostate gland and the seminal vesicles. There are three types of prostatectomy: Open, laparoscopic and robotic.
Advantages:
- Prevents cancer spread to other tissues.
- Cures the cancer if cells have not spread outside the prostate.
- You will find out if the cancer has developed into the
surrounding tissues.
- It will also treat BPH and its symptoms
Disadvantages:
- Major operations always carry risks such as bleeding, injury to nearby tissues and nerves, chest infection, blood clots in the lower leg and wound infection.
- Between 50% and 70% of men suffer impotence
- 5% men suffer permanent urinary incontinence
- Requires hospitalization for 4 to 6 days and a six week
recovery period
- Can cause urethral stricture (narrowing of the urethra) in 5% patients
- Infertility – as the prostate and seminal vesicles, which produce and store some of the fluid in semen, are removed during the operation.
- Bladder neck obstruction – a small number of men have problems passing urine after surgery due to the build up of scar tissue around the neck of the bladder. This would need to be corrected with a short operation.
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