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Episode 11

Treatment Options for Prostate Cancer

Prostate Cancer Treatment Options

The purpose of the Movember movement is to create awareness among MEN and women regarding prostate cancer. I want to emphasize how important it is for men to go to their urologist and get their prostates checked.  We all know women tend to be more responsible than their male counterparts when it comes to their medical care and health.   Why?   Us Men feel we are invincible, strong, machos, heroes, the main character in the movie, and silverback gorillas. Moreover, it isn’t until we start feeling very sick or have multiple problems, that we decide to go to the doctor.

Prostate cancer is CURABLE!

One out of 9 men will be diagnosed with prostate cancer. If you are African American or have family history of prostate cancer, that risk is even higher!  Nevertheless, when the cancer is detected early, it can be CURED.   You read it correctly. Prostate cancer is CURABLE!

Today I wish to discuss the various treatment options we have available when men are diagnosed with prostate cancer.  Which treatment option will be best for you will depend on the aggressiveness of the cancer, urinary symptoms, and other health factors or what doctors call: comorbidities.

Active Surveillance for Prostate Cancer

This option is good for patients who have a less aggressive cancer, or what urologists call “low risk or very low risk”.  Some men on active surveillance may not need treatment, ever.  During active surveillance, the patient follows up periodically with certain blood tests, rectal exam, and imaging studies along with repeat biopsies to actively monitor any progression of the cancer.  If it progresses to a ‘higher risk’, the doctor treats the cancer.

Surgery for Prostate Cancer

Surgery involves removing the prostate gland (called radical prostatectomy). Nowadays, the vast majority of urologic surgeons do this surgery with the assistance of a robot.  Men who decide to undergo surgery carry a risk of developing urinary incontinence, or leakage of urine, along with erectile dysfunction.

What are the advantages?

  1. The surgeon takes the entire prostate out.  If the cancer is localized or contained inside the prostate, you walk out of the operating room FREE OF CANCER.  It is a one-time deal.  You go in to the OR with cancer and, when you get out, it’s over.
  2. The surgeon removes the prostate and a pathologist will analyze it under the microscope to determine the extent, location and grade of the cancer.
  3. If the patient has bothersome urinary symptoms with obstruction: taking the prostate out will solve this problem.
  4. Your urologist will be able to monitor for possible recurrence better. Why?  When the prostate is removed, the PSA test will become undetectable within 6 weeks.  Given that the PSA, in some cases, may never become undetectable after radiation, this test can be less reliable for post-radiation patients.

What are the disadvantages?

  1. The possibility of long-lasting bladder control problems.  For men below 65 years old, approximately 5% will have significant urinary leakage.  (the risk with Radiation is 1-2%).
  2. Erectile dysfunction can occur in approximately 60% of patients.

Radiation for Prostate Cancer

Radiation uses high potency x-rays that will kill the cancer cells.  There are different ways a doctor can apply the radiation.  Radiation can also cause problems with urine control and erectile dysfunction.

What are the advantages?

  1. It is easier to undergo than surgery.  Recovery from surgery is usually 1 to 3 weeks, whereas recovery from radioactive seed implantation is 1-2 days.  For patients who choose radiation, most will also undergo daily external beam treatments for 6 to 7 weeks. However there are no incisions, no cuts, and most of the time, no pain.
  2. Risk of poor bladder control is significantly less (1-2%).
  3. Risk of erectile dysfunction is lower than surgery, approximating 20 to 40%.

What are the disadvantages?

  1. Some patients can experience difficulty emptying the bladder.  So if you experience frequent urination and decreased force of the urinary flow, the likelihood of long-lasting symptoms following radiation therapy increases.
  2. Some of the side effects can occur many years after treatment. These include bleeding in the urine and bleeding stools, although these are rare.

So which one should I choose?

The most important thing you need to know is that cure rates approximate 98% with BOTH surgery and radiation. Urologists offer both treatments for patients who have their cancer limited within the prostate.  Surgery is dependent on ONE factor to be successful:  location of the cancer.  If it is contained within the prostate gland, it cannot return following removal.  With radiation, 3 things must happen:

  1. The cancer must be confined to the treatment area.
  2. Cancer cells must respond by DYING.
  3. The entire normal portion of the prostate must “die” to eliminate the future source of prostate cancer.

In Conclusion…

The take home message for today’s #GatekeepersofMen post is: if you are a male above 50 years old, go see a urologist and get your prostate checked.  We want you to live worry-free. If the doctor finds cancer and it is still contained within the prostate without signs of spreading, you can be CURED.

How often can we associate the word CANCER with a CURE? That is Movember’s purpose.  Screen for cancer, help you learn about the treatment options for prostate cancer, and (if present) cure it and let you live a longer life, cancer free.

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is an urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH.

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