Minimally invasive treatment options
Brachytherapy
Brachytherapy is an incision-free surgery and is a minimally invasive treatment option that administers radioactive seeds (the size of a grain of rice) directly into the prostate. Low Dose Rate Brachytherapy has proven long term results1 and in most cases the treatment is completed in one2 outpatient visit. It is one of the few treatments available for treating prostate cancer with a much lower risk of impotence (erection)3.
The radioactive seeds are placed into thin needles and are directed into the prostate through the perineum. The seeds release low dose radiation for several weeks or months, killing the cancer cells.
Brachytherapy is an outpatient procedure which does not require hospital stay. Most patients return to work or their normal activity within a few days.
Potential side effects include frequent urination, incontinence (blockage of urinary flow), soreness or discomfort and impotence. However, recent studies have shown that some of these side-effects are not permanent.
Benefits of Prostate Brachytherapy:
- Outpatient procedure averaging 45 minutes
- Hospital stay is not required in most cases
- Patient may return to normal activities within a few days
Cryotherapy
Cryotherapy uses argon gas to freeze and helium gas to thaw. This process destroys cancer cells in the prostate. A warming catheter is inserted through the urethra to protect it during the freezing process of the prostate. The cancer cells in the prostate are destroyed as they thaw.
- Procedure normally takes about 2-3 hours to perform
- Requires general or spinal anesthesia
Even though Cryotherapy is considered an outpatient procedure it may require an overnight stay.
Major side effects include:
- Permanent impotence may occur since nerves influencing sexual potency may be effected by the freezing process
- Urethral sloughing, when dead or necrotic tissue which is produced by the procedure can fall off into the bladder and bladder neck blocking the urine stream
External Beam Radiation Therapy (EBRT)
The first step in the external beam radiation treatment is to determine the exact location of the prostate. Once this area is marked, varying doses of electromagnetic radiation is administered to the pre-determined area, as well as the area surrounding the pelvis.
Doses are normally administered five days each week over the period of approximately eight weeks.
Potential side effects include diarrhea, rectal bleeding, frequent and painful urination and impotence.
Intensity modulated radiation therapy utilizes three-dimensional imaging in the delivery of treatment dosage. This option delivers advanced and precise treatment, as very small beams of varying intensities are aimed at the tumor from multiple angles. Additionally, the shape of the beam continuously alters itself and maneuvers around healthy tissue to minimize damage.
Potential side effects include diarrhea, rectal bleeding, frequent and painful urination and impotence.
Surgery
Radical Prostatectomy
A radical prostatectomy is the surgical removal of the entire prostate gland. This procedure is normally performed during early-stage prostate cancer and if the cancer is contained within the prostate and has not spread.
The obvious drawback in choosing this option is that it is a major operation which requires hospitalization. Additionally, the side effects related to a radical prostatectomy include:
- Impotence and incontinence
- Requires 2-3 day hospital stay
- 2 or more weeks required for recovery
Impotence, or erectile dysfunction, have been reported in the majority of patients undergoing this surgical treatment. However, if the nerves are not left intact during surgery, impotence is almost certain. High incontinence rate, involuntary urination, has also been reported.
Robotic Surgery is the surgical removal of the entire prostate gland through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
Orchiectomy
Orchiectomy, or "castration", is the surgical removal of the testicles. Although an uncomfortable option for most men, it is a relatively painless and inexpensive procedure and produces almost immediate results. Orchiectomy is normally an outpatient procedure and has minimal surgical complications. This treatment is effective in its immediate and permanent reduction of testosterone production.
Side effects can include loss of sex drive, difficulty achieving an erection, hot flashes and loss of bone density. Further, this treatment can also have a significant negative psychological impact on some men. These effects may be minimized by the consideration of testicular prosthetics or opting for a procedure that removes only the contents of the testicles without removing the "shell".
Other Options
Another option is Active Surveillance / Watchful Waiting
Active Surveillance / Watchful waiting, or observation, is a possible option for men with low grade and low stage prostate cancer. Men that choose watching and waiting may have low tolerance for other therapy options or may feel that the benefits of treatment will not outweigh the negative side effects. This option does not involve any active therapy, but rather monitors the progression of the cancer and development of symptoms. During watchful waiting, a PSA blood test and DRE are recommended every six months, along with an annual biopsy. If symptoms arise or the results of these tests conclude that the cancer is spreading, an active treatment option will likely be recommended by your physician.
Most doctors now believe that radical prostatectomy and brachytherapy have about the same cure rates for early stage prostate cancer. Source: Cancer.org |
|
Patients choosing External beam radiation therapy (EBRT) are usually treated 5 days per week, over a period of 7 to 9 weeks. Source: Cancer.org |
|
The major possible side effects of radical prostatectomy are urinary incontinence (being able to control urine) and impotence (being unable to have erections). Source: Cancer.org |
The information provided above is not intended to replace medical advice, you should seek the expertise and judgment form your cancer care team.
For the most comprehensive assessment of the available treatment options and expected outcomes request a consultation with all three types of prostate cancer specialists: Urologist, Radiation Oncologist, Medical Oncologist
