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The choice of any specific prostate cancer treatment option depends on a
number of factors.
Some of these include:
your age
your general health
your mental stability
the extent of progress of your prostate cancer
side effects of different treatment options, and
the effectiveness of the treatment options.
It is not easy to make such a difficult decision. You may want to discuss with
your family and friends or get opinions of other doctors.
You may want to talk with other patients and learn of their experiences.
But, it has to be in accord with what the medical fraternity thinks is the best
for your situation.
Prostate Cancer Treatment Options
Treatment options normally depend on the extent of your prostate cancer. If
your prostate cancer has spread to major body parts, radiation or surgery
could be the best options.
If it is in the initial stages, active surveillance may be a good option.
(I) Radiation Therapy
This therapy uses high radiation levels to kill the cancer cells or restrict their
growth with minimum damage to other healthy body cells.
Radiation therapy is of two types:
External radiation with the help of a radiation machine directed at the
prostate and Internal radiation by implanting radioisotopes through thin
plastic tubes into the affected area either permanently or temporarily.
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External Radiation sessions normally consist of five days each week spread
over eight to nine weeks. The radiation therapist would place you in a specific
position on the treatment table. The radiation treatment then starts with the
help of the radiation machine.
You do not feel anything during the treatment. This treatment involves
passing the radiation rays through your body to kill cancerous cells.
Therapists take weekly X-rays or port films to check if the treatment is
addressing the affected area specifically. These X-rays do not provide any
information about the progress of your disease.
Therapists could also mark specific areas on your skin as an identification
mark.
Side Effects: Skin exposed to radiation could become swollen, reddish,
sensitive and warm. Sometimes, it could peel around the area. Skin reactions
are temporary and go away after four to six weeks of completion of
treatment.
Hair loss and increased perspiration are added side effects.
Long-term side effects include enlarged pores, darkening of skin, thickening
of tissue and change in sensitivity levels of skin, urinary problems like
frequency and bleeding and erectile dysfunction.
Radiation therapy could make you feel mildly fatigued, although you can
continue with your regular routine. It is best to plan and pace your activities
and take lots of rest.
Eating nutritious and well-balanced meals can help you overcome fatigue.
(a) 3-D conformal radiation therapy with CT
If your cancer is localized within the prostate, undergoing 3-D conformal
radiation therapy with CT may deliver results that are more precise.
Radiation is from different directions and minimizes damage to normal
tissues.
This therapy can cause side effects like diarrhea, inflammation of the rectum,
impotence and incontinence.
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(b) Intensity-Modulated Radiotherapy (IMRT)
Intensity-Modulated Radiotherapy (IMRT) is a very precise and advanced
technique of delivering radiation beams according to the shape and depth of
the prostate cancer.
After completion of radiation therapy sessions, you have to schedule your
follow-up tests and checkups with your doctor.
(II) Radioactive Seed Implants
This is another type of radiation therapy. This is the same as
Brachytherapy. It involves planting of radioisotopes permanently or
temporarily. This is a newer treatment option for prostate cancer. It is
claimed to be as effective as regular external radiation and radical
prostatectomy in ten-year follow-up studies.
Permanent Brachytherapy (Low Dose Rate or LDR)
Your doctor implants around forty to a hundred iodine-125 or palladium-103
radioactive seeds into the prostate gland with the help of an ultrasound.
Implantation is according to a computer-generated plan best suited for your
condition. These implants become inert after a specific period, although they
remain permanently within your prostate. These implants help deliver
maximum radiation within your prostate without affecting other body tissues.
Temporary Brachytherapy (High Dose Rate or HDR)
This involves placing hollow needles filled with iridium-192 into the prostate
for around five to fifteen minutes. Then, your doctor removes the iridium and
the needles.
You undergo two or three similar sessions spread over several days. The
implants remain permanently but they become inert after about ten months.
The entire procedure could take around an hour and a half each time.
This treatment best suits prostate cancer patients with PSA levels lower than
10, Gleason score equivalent or less than six, almost no abnormality on the
digital rectal exam, less aggressive cancer, and cancerous growth restricted
within the prostate.
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Side Effects: These are primarily urinary-related. They include frequent
urination, inability to totally empty the bladder and a burning sensation
during urination.
Diarrhea, rectal bleeding, and urinary incontinence as side effects are very
rare. The impotence rate could be 25% after five years of treatment and
could increase to 50% if you also undergo hormone therapy.
You should restrict prolonged contact with children and pregnant women for
around two months after treatment.
(III) Chemotherapy
This treatment option is specifically for recurrent or advanced prostate cancer
cases. It could also deliver results where hormone treatment has been
ineffective.
Chemotherapy is not for treating prostate cancer in the early stages. The
complete treatment extends for three to six months according to the type of
chemotherapy medications.
The treatment is divided into specific cycles and recovery periods.
Chemotherapy medications are normally given intravenously and rarely
through the mouth. The drugs pass through the bloodstream and reach
cancerous cells anywhere in the body.
This treatment helps shrink cancer cells and may make them disappear
completely.
Side Effects: Just as chemotherapy kills the fast-dividing cancer cells, it also kills healthy cells across the hair follicles, gastrointestinal tract lining,
membranes lining the mouth and in the bone marrow.
However, these are temporary side effects and the healthy cells may soon
grow back.
Other side effects include loss of appetite, hair loss, diarrhea, vomiting,
nausea, mouth sores and permanent infertility.
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A low count of white blood cells increases the risks of infection, while a low
count of blood platelets and red blood cells may cause anemic fatigue and
bleeding or bruising from minor injuries.
You can take medications for these side effects according to the advice of
your doctor.
(IV) Radical Prostatectomy
This is surgical removal of the prostate gland with some of the surrounding
tissues. Doctors may prescribe this treatment for men under the age of
seventy without any major health problems if your prostate cancer is
localized.
Radical prostatectomy is of two types:
Retropubic prostatectomy and
Perineal prostatectomy
Retropubic prostatectomy: Your surgeon makes an incision in the lower
abdomen to remove the prostate, surrounding tissue and lymph nodes if
necessary.
The surgeon would locate nerves on either side of the prostate and check if
prostate cancer has spread to these nerves. The surgeon would not remove
them if they are not affected, as these nerves are necessary for an erection.
This will reduce the chances of erectile dysfunction and incontinence after the
surgery.
The surgery could last two to four hours.
Perineal prostatectomy: With this surgery, the surgeon makes an incision
in the skin between the scrotum and the anus. The surgeon, if necessary,
removes the prostate and some lymph nodes.
This surgery is not very common as it is difficult to use nerve-sparing
techniques.
This surgery could take a little less time than retropubic surgery.
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Surgery risks involve bleeding, infection and blood clots in your legs that
might sometimes travel to the lungs (Medical staff monitor you for any sign
of clots).
The recovery period for these operations is normally a stay of three days at
the hospital. You may have to stay away from work for around three to five
weeks.
Surgeons normally insert a catheter through the penis into the bladder
during the surgery. This remains so for ten to twenty-one days to help easy
urination during the recovery period.
Side Effects: These include urinary incontinence and impotence. But, you
may recover normal continence levels within six months of surgery.
(V) Laparoscopic Prostate Surgery
This surgery is done with the help of a laparoscope. This has a special
camera. The surgeon makes small incisions of five to ten millimeters below
the belly and passes carbon dioxide through a small tube. This lifts the
abdominal wall and allows a clearer view through the laparoscope.
The laparoscope transmits a picture of the prostate onto a video monitor.
This surgery is the best option if your prostate cancer is not aggressive and
has not spread beyond the prostate. However, if you have had any pelvic
laparoscopic surgery or undergone hormone treatment for prostate cancer,
you should not opt for this treatment.
This surgery is less invasive, recovery time is less and you need fewer
medications.
Chances of infection are very low and your hospital stay is much shorter. You
can go back to work within two to three weeks. The effectiveness of this
treatment option is the same as that of the other operations.
Side Effects: These are similar to invasive surgery; side effects may include
impotence and incontinence. Urinary infections may exist for the initial two to
three months.
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As this technique is comparatively new, there is not enough evidence as to
whether it leads to higher rates of potency.
For around six months, you should refrain from lifting heavy loads or do any
abdominal exercises like sit-ups.
(VI) Hormone Therapy
This treatment involves removal or blocking of hormones to treat prostate
cancer. It is the same as androgen suppression therapy or androgen
deprivation therapy.
This treatment may be effective if your prostate cancer has spread outside
the prostate. It may reduce the progression of the cancer effectively and
offer better survival rates.
In some cases, doctors recommend hormone treatment after surgery for
better treatment of prostate cancer.
The prostate grows further if exposed to the male hormone testosterone and
androgens. Hormone treatment can stop production of testosterone and all
androgens temporarily or permanently.
This treatment can be through injections, pills, and drugs.
Occasionally, it involves surgical removal of the testicles that produce
testosterone. This prevents any further stimulation of prostate cancer.
Sometimes, hormone therapy is used as an effective treatment option
before, during or after local treatment.
The LHRH or GnRH is a luteinizing releasing hormone, and Gonadotropin-
releasing hormone is one of the most important hormones released by the
body before production of testosterone.
Hormone therapy aims at blocking the release of LHRH or GnRH through use
of LHRH agonists or LHRH analogues.
Doctors normally prescribe monthly shots of Eligard, Lupron, Viadur, Trelstar
and Zoladex. In some cases, dosage could be tri-monthly, quarterly or yearly
depending on the aggressiveness of your prostate cancer.
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Most of the cancerous cells in the prostate respond positively after removal
of testosterone. Yet, some cancerous cells grow independently of
testosterone.
Hormone therapy is unable to kill these cancerous cells. So, despite
undergoing hormone therapy, cancer may still spread within your body.
Hormone therapy is not always a very effective treatment option.
But, it may contain and restrict your prostate cancer.
Orchiectomy
Some men choose to undergo Orchiectomy. This is surgical removal of the
testicles. Since over ninety percent of testosterone production is in the
testicles, removing them can be a good option.
Nonetheless, orchiectomy being a nonreversible and a permanent surgical
solution, many men are adverse to it and opt for drug therapy instead.
(VII) Active Surveillance
Although this is not a treatment option in the strictest meaning of the term,
it is a way of combating prostate cancer.
If surgery or hormone treatments do not seem viable, you can adopt a wait
and watch attitude to follow up your prostate cancer.
However, you still need to undergo PSA and DRE examinations every six
months, with a yearly biopsy.
Your doctors will have to review the progress of your prostate cancer
minutely. If there are any indications of a growing prostate cancer with any
advancing symptoms, doctors would then advise immediate surgery or other
more suitable treatment options.
This technique is a good choice for men with slow-growing cancers or if you
have other serious medical conditions that could shorten your lifespan.
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(VIII) Other Treatment Options
Although surgery, hormone treatment and radiation therapy are the
traditional treatment options available, there are a few less popular
treatment options also. These include:
(a) Cryotherapy: This treatment option has been available for some time but is used rarely. This surgery involves insertion of probes into the prostate
through the perineum and passing of liquid nitrogen or argon gas through it.
This freezes prostate tumors and cells.
However, it can cause serious erectile and urinary dysfunction. This therapy
is the same as cryoablation or cryosurgery. If you have been using hormone
or radiation therapy, this option may not deliver good results.
(b) High-Intensity Focused Ultrasound: This treatment option involves
killing prostate cells with heat. Through this treatment, a probe is inserted
into the rectum through which high-intensity ultrasound waves are delivered.
This treatment option is still in the experimental stages.
(IX) Emerging Therapies
Scientists and researchers are trying to discover newer therapies to
overcome shortcomings of the therapies and treatments in use for prostate
cancer. Often, prevalent treatments destroy existing good cells of the body
and thereby reduce the capability of the overall immune system.
However, the FDA has not yet approved any specific therapy for use in
prostate cancer. Nonetheless, researchers are sure that soon there could be
more targeted therapies for use in treatment of prostate cancer.
They believe that these therapies might offer better results and possibly with
less severe side-effects or no side-effects.
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Coping with Prostate Cancer – The Action Plan
Prostate cancer diagnosis and treatment can prove very stressful and
overwhelming. It will be easier if you draft a coping action plan to coordinate
and sustain all these facets.
Coping Help Sources
You and your family can take help from the different sources available. These
sources provide necessary help in a professional and supportive manner.
These include:
Counselors
Professional and trained counselors can help you overcome your innermost
doubts and tackle difficult feelings. These counselors offer you individual time
and attention. They listen to all your queries patiently and address all
possible consequences of prostate cancer on your life. They can draft suitable
strategies that help you get control over your life and thereby enjoy a better
quality of life. Sometimes, such counselors could prescribe medications to
treat depression.
Social Workers
Social workers offer help and counseling regarding your prostate cancer
diagnosis and treatments. They educate you about possible concerns,
adjusting to lifestyle changes, and refer to national agencies or support
groups. They arrange for temporary lodging and look after all your other
requirements.
Support Groups
Support groups are made up of people dealing or having dealt with similar
experiences. You can take part in discussions of support groups, meet others
with similar prostate cancer symptoms as you, learn from their experiences,
and understand how they are coping with the disease. This offers an
immense psychological boost that you are not alone in your disease; there
are many others suffering similar feelings and experiences. This gives greater
mental strength to face the situation. However, never substitute your
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doctor’s advice with that of any member of the support group. Follow your
doctor’s advices religiously.
Financial Counselors
Financial factors prove to be a major cause for worry for most prostate
cancer patients. There are financial counselors available through your
hospital, or your doctor can give you the necessary information. Talk and
discuss your financial position and decide about how best you can
accommodate your additional expenses for prostate cancer treatments.
These counselors would offer necessary advice about all financial issues
regarding your prostate cancer treatment.
Gather Information
Try to collect as much information about prostate cancer as possible from
various sources like the Internet, medical journals, medical organizations,
and professionals in this sphere. Collection of information can help you
understand the disease in its entirety and remain prepared for all
consequences.
Family
Family members and, especially your spouse, will have to play a major role
in your coping plan for prostate cancer.
Take the time to have a frank discussion of all pros and cons of your prostate
cancer.
You both can visit and talk with your doctor to learn about the possible side
effects of treatments or symptoms.
This helps your spouse prepare to handle any emergencies.
Home
Domestic affairs take a backseat and, often, there could be frequent
disruptions in the regular household routines due to your prostate cancer
treatments.
Organize help at home.
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You can engage trained nurses at home to help with giving injections,
bathing, administering medications and looking into all your medical
requirements.
You can engage domestic help to look after regular household chores.
Your spouse would be definitely stressed because of your ailment and
treatments. Having such people to help at home can be a great boost and
stress reducer.
If need be, you can ask your friends or neighbors to give a helping hand.
Personal Strategy
Although these coping strategies may provide an effective action plan to
reduce the effects of your prostate cancer and treatment, you should
maintain a positive attitude and remain optimistic.
Always express your feelings and emotions openly without bottling up your
guilt or grief. Talking over matters makes you feel better and relieves stress
from your body.
This is essential as high stress levels can cause excessive spreading of
prostate cancer cells.
Impotence is a major effect of prostate cancer. This is a very personal matter
for discussion between you and your spouse. Develop and maintain easy and
open communication channels.
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Prostate Cancer Treatment and Stress
The existence of prostate cancer can cause a lot of stress. You may fear
possible consequences, be wary of the selected treatment options and how
effective they could prove to be.
You may be unsure of your future, with the possibility of disability and
financial problems due to your prostate cancer treatment.
Stress due to prostate cancer translates into fatigue, disturbed sleep,
anxiety, body aches and pain, headaches, irritability and tension.
Scientists from Wake Forest University School of Medicine are the first to
have published reports in Science D