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Prostate Cancer Treatments:
Hard Questions Honest Answers

Of the prostate cancer treatments
available which one is best when it
comes to survival and complication rates?

Charlie Cotter took nearly six agonizing months to sort through the various prostate cancer treatments available to him and his early stage prostate cancer. As the operator of his own HVAC business the 53 year old was used to making hard decisions quickly. So indecision wasn’t the issue.

No, in the case of the cancer located in his prostate gland he quickly realized there’s a little known but distressing reality. No medical professional he consulted with could tell him with certainty which therapy was the best bet for his situation. He was presented with no clear cut winner. Which left him debating the pros and cons of various options with a string of medical professionals in the hope of eventually figuring out which was best for him.

Charlie’s dilemma is somewhat understandable. What with the rapid and ongoing advancement and innovation in the field of medicine, prostate cancer specifically, there are now many prostate cancer treatments to choose from. Guess one could say options abound. Which could, or is it should?, be seen as a good thing.

Prostate Cancer Explained: This is a cancer that attacks the prostate gland located in the male reproductive system. In most cases the prostate cancer cells grow slowly. Less often the cancer cells can be more aggressive. Obviously the more aggressive strain can kill sooner. Yet the stats show that while one in six men will be stricken, only one in 34 will die from this type of cancer. Diagnosis is clearly no death sentence.

Typical Prostate Cancer Treatments

That may be because of the long and growing list of the typical prostate cancer treatments available to you. Brachytherapy, chemotherapy, cryosurgery, cryotherapy, hormone therapy, radiation therapy, prostatectomy, robotic prostatectomy should all be present and accounted for. All should be on the table for consideration too. As should watchful waiting or keeping a close eye on the situation to see if you even need to treat it at all.

See the problem?

On top of that there is precious little medical research available that gives a side by side comparison of the various treatment options. Which ideally would highlight the tradeoffs of one verses another. Something the newly diagnosed could really use to help sort through their choices.

Instead what you are presented with is a brief overview of the treatment options much like what follows. Each with their own advocates. Each with their own advantages and disadvantages. Unfortunately too often a lack of solid info can result in choices made out of fear or misconceptions rather than solid evidence.

Brachytherapy

Brachytherapy is one of the many prostate cancer treatments. This method is considered to be a minimally invasive therapy. It makes use of radiation therapy implants. The radiation brachytherapy implants come in low dose radiation (LDR) and high dose radiation (LDR) seeds which are inserted directly into the prostate.

The brachytherapy seeds are said to be more effective for younger patients who are in good health with only localized prostate cancer cells. The minimally invasive surgery usually lasts between 1 to 2 hours with the possibility of an overnight hospital stay. Multiple long-term studies indicate recurrence-free survival rates of 77% to 93%. Side effects of undergoing brachytherapy include possible bleeding at the site, blood in the urine, impotence, and incontinence.

This approach is increasingly popular because it’s convenient and less disruptive to your everyday life. You can go back to work or resume normal activities right away.

Chemotherapy

Prostate chemotherapy is another form of prostate cancer treatment. Chemotherapy may be administered to patients who are suffering from advanced prostate cancer or if the disease had already spread out across the different organs of the body.

Recurrent prostate cancer in patients who have stopped responding to other forms of prostate cancer treatments may benefit from chemotherapy. Salvage chemotherapy is administered either orally or through a computerized pump. This type of treatment may also be administered through frequent injections. Chemotherapy may relieve pain and it may also slow down the growth of the tumor in more advanced cases. On the downside, chemotherapy may cause hair loss, mouth sores, nausea, and vomiting.

Cryosurgery and Cryotherapy

Prostate cancer treatments also come in the form of cryosurgery and cryotherapy. Prostate cryotherapy is a minimally invasive procedure which makes use of needles to apply freezing gases to the affected gland to eliminate the cancerous cells.

Prostate cryosurgery is used in patients who are suffering from localized cancer with Gleason scores of under 6, PSA levels of under 10, or external radiation recurrent cancer. While long-term clinical results of cryosurgery are limited, these outcomes are still promising. Side effects of cryosurgery treatment include pelvic pain, scrotal swelling, mild urinary urgency, impotence and blood in the urine.

Hormone Therapy

Hormone therapy is a form of prostate cancer treatment that suppresses, eliminates, or blocks testosterone in order to slow down the growth of the tumor. Prostate hormone therapy not only helps by slowing the growth of the cancer but it can also lower the level of PSA.

Hormone therapy may be used before, after, and while other treatments are being administered to a patient. Surgical castration patients usually return home immediately after surgery. The treatment is given either through injections or oral medications. While hormone therapy will not destroy the cancer cells, research has shown that it helps increase the effectiveness and potency of other treatments. Common hormone therapy side effects include impotence, hot flashes, loss of muscle mass, weight gain, and fatigue.

Prostatectomy

Prostatectomy is the complete removal of the prostate gland through surgical incisions made in the perineum or abdomen. This may also be done through the use of a laparoscopic device which creates small incisions. Since prostatectomy procedures carry some surgical risks and possible side effects, this type of prostate cancer treatment is usually recommended for younger patients who have good overall health.

The duration of a prostatectomy, the recovery period, and the hospitalization may vary according to the type of prostatectomy method used. According to studies, survival rate of patients who have undergone prostatectomy with recurrence-free success rates is over 90%. The risks associated with prostatectomy include surgical complications, incontinence, and impotence.

Side effects aside, this is the option those who want the cancer out and gone.

Radiation Therapy

Next on the list of prostate cancer treatments would be prostate radiation therapy. Electron beam radiation therapy or EBRT targets prostate cancer cells with external radiation. Prostate radiation therapy such as the IMRT and the 3D-CRT are the more developed versions of the EBRT. All are considered to be non-invasive.

This type of prostate cancer treatment usually requires 5 sessions per week over a period of 6 to 8 weeks. Multiple long term studies and short term studies indicate success rates of over 85% especially when used in conjunction with other types of treatments. Radiation therapy may cause side effects such as skin irritation, frequent or burning urination, prostatitis, diarrhea, tiredness, and upset stomach.

Robotic Prostatectomy

Robotic prostatectomy is another form of prostate cancer treatment. This is a minimally invasive procedure which involves the removal of the prostate and surrounding cancerous cells. This minimally invasive robotic surgery is reserved only for the use of patients whose cancer cells are only confined to the prostate gland.

During the process of a robotic prostatectomy, the use of surgeon-controlled robotic arms serves as the main device to remove the prostate gland. Clinical research reveal impressive outcomes compared to the more traditional retropubic procedures. Some of the risks of that patients experience after robotic prostatectomy include incontinence, impotence, blood loss, and surgical complications.

Watchful Waiting

Watchful waiting shouldn’t be confused with doing nothing. Instead, active surveillance, as it’s also known as, incorporates careful periodic monitoring of the situation.

Candidates for active surveillance are generally older. Ideally your urologist will be looking for a Gleason score of 6 or less and PSA level of 10.0 or less which suggests a small slow growing cancer.

You will likely be asked to undergo a digital rectal exam and PSA blood work every six months. And a needle biopsy perhaps every 12-18 months. Only when signs of progression of the tumor develop would treatment be initiated.

The benefit here is you avoid unnecessarily treating a non life threatening situation and the possible side effects that come with that. Or at least you delay it for as long as is reasonably possible. Which some see as a huge plus.

Bottom Line

Fact is, as Charlie found out, in the end you are the only one who can weigh the outcomes. Only you can weigh out the tradeoffs of possible cure verses living with potentially long term side effects of treatment. In his case he went with brachytherapy. Although he was still uncertain of his decision, things are looking good.

Those most concerned about the side effects often go with watchful waiting. While those who find living with cancer festering in their prostate keeps them up nights often choose a more aggressive course of action. One that involve some form of prostate cancer treatments which will address the problem head on.

prostate cancer treatments