•  Prostate Health Center

Every year, 234,000 American men learn they have prostate cancer. It's bad news, but it isn't likely to be a death sentence. Thanks to widespread screening, nearly 90 percent of prostate cancers are detected before they spread beyond the gland. At this point, the disease is highly curable.

Men with early-stage prostate cancer have more options than ever before, enough to present many patients and their doctors with a dilemma. Every treatment has potential benefits and drawbacks, so which is the right route to take? The answer depends on many factors, including the size and aggressiveness of the tumor, the age and health of the patient, and the patient's personal preferences.

Here's a look at the most common treatment options for early-stage prostate cancer. If you've recently been diagnosed with the disease, this overview can help you and your doctor choose a therapy that's right for you.

The most aggressive approach to prostate cancer is also the most common. Radical prostatectomy -- complete surgical removal of the prostate gland -- is considered to be the most effective treatment for prostate cancer, according to the February 2001 issue of Geriatrics. This approach makes especially good sense for relatively healthy patients under age 65. For one thing, such men generally have the strength to handle a major operation. Radical prostatectomy also gives them the best chance for a long-term cure. Even if a young patient lives another 40 or 50 years or longer, the cancer won't ambush him down the road.

On the downside, radical prostatectomy is major surgery. Most patients have to stay in the hospital for two to three days, and they usually have to recuperate for a month before returning to work. The operation can also damage nearby nerves, often causing problems with urine control and erections.

Fortunately, the damage usually isn't severe enough to sink a man's quality of life. While up to 35 percent of patients tend to leak a little urine accidentally while coughing or laughing, very few become seriously incontinent. Although up to 70 percent have some degree of erectile dysfunction, or impotence, the problem is sometimes temporary, especially in younger patients who didn't have any erection troubles before the operation, according to the American Academy of Family Physicians.

However, in some cases, surgery may cause permanent impotence. You should speak to your doctor about a fairly new type of surgery that can spare the nerves affecting erections. This surgery, however, isn't recommended for men who have large tumors or tumors that are very close to the nerves.

Even if the nerves that control erections are severed, some men can still have normal feelings in their penises and can still have orgasms. Several medications and devices can help such men achieve erections and enjoy a complete sex life.

Instead of removing the entire gland, healthy tissue and all, doctors can use radiation to target and kill the cancer cells. There are two ways to deliver the radiation. In a process called external beam radiation, a machine produces a highly focused beam of energy aimed directly at the tumor. It usually takes about five sessions a week over seven weeks to treat the tumor. Alternatively, a doctor can implant radioactive pellets or "seeds" in the tumor. This is called seed therapy or brachytherapy. It's a minor procedure, and most patients go home the same day it is performed.

Radiation therapy has some obvious advantages over radical prostatectomy. First and foremost, the patient avoids major surgery. The recovery time is minimal, and there's little risk of serious complications, even if the patient is relatively old and sick.

Radiation, however, can be hard on the body. Patients often feel exhausted at the end of their treatment. And roughly half of all radiation patients become impotent within two years, according to the American Academy of Family Physicians. This complication is more common with external beam radiation than with seed therapy. As reported by the American Academy of Family Physicians, up to 30 percent of all patients will briefly suffer other unpleasant side effects such as rectal bleeding, burning during urination, frequent urination, and diarrhea.

In short, neither form of radiation treatment is a walk in the park. But when it comes to quality of life after the operation, seed therapy seems to have the advantage. A survey of 842 patients published in the November 2001 issue of the Journal of Urology found that those who underwent seed therapy generally felt healthier and were more active than those who had external beam radiation.

Perhaps the biggest drawback to radiation treatment is uncertainty. Unless a surgeon cuts open a patient and physically removes the tumor, there's no way to be sure that every single cancer cell has been destroyed. Any remaining cells may eventually form new tumors 10 or 15 years later. For this reason, radiation isn't usually recommended for young patients with decades left on the clock.

Prostate cancer is often a very slow-growing disease. It can take 10 years or more for a small tumor to spread beyond the gland and pose a serious threat to health. For this reason, the best course of action may be no action at all. If a man is already advanced in years or in poor health, radiation or surgery may not prolong his life. After discussing the situation with their doctors, many men decide that the side effects of treatment outweigh the potential benefits.

But that doesn't mean the cancer should be ignored. The doctor will conduct regular blood tests to measure the level of prostate-specific antigen, a sign of tumor growth. If the cancer starts growing faster than expected, treatment may be warranted after all.

Cryosurgery
In recent years a new treatment has been developed that destroys prostate cells through freezing. Called cryosurgery or cryotherapy, this treatment is sometimes used when cancer is limited to the prostate gland. In this procedure, the doctor uses hollow needles to transmit freezing gas to the targeted area, using ultrasound images to guide the way.

Cryosurgery is less invasive than a radical prostatectomy, but not much is known about its long-term effectiveness. For this reason, it isn't usually considered a first line of treatment. It is sometimes recommended when cancer returns after surgery or other treatment.

Since freezing also damages nerve cells near the prostate, most men who undergo cryosurgery will be impotent. Other side effects may include blood in the urine, soreness, and swelling for a few days after surgery. Sometimes cryosurgery affects the bladder and bowels, causing pain and the urge to go to the bathroom frequently, but this usually goes away in time. According to the American Cancer Society, side effects from cryosurgery tend to be more severe in men who have received radiation therapy.

Hormone therapy
Prostate cancer that has spread beyond the prostate gland can no longer be cured, but it can be slowed down. Doctors can put the brakes on the disease by injecting the patient with female hormones called LHRH agonists. These hormones block the supply of testosterone, a male hormone that helps fuel prostate cancer. In advanced cases, a surgeon can permanently stop the flow of testosterone by removing the testicles.

When testosterone levels plummet, prostate cancer tends to shrink. Unfortunately, hormone therapy is only a temporary fix. The cancer doesn't disappear completely, and it usually starts growing again within one or two years. At this point, there is little a doctor can do to stop the spread of cancer.

Not surprisingly, hormone therapy causes some unpleasant side effects. Many men develop enlarged, tender breasts. Other possible side effects include hot flashes, erectile dysfunction, and loss of interest in sex.

Chemotherapy
In cases where prostate cancer has spread and hormone therapy hasn't worked, a doctor might recommend chemotherapy, in which anti-cancer drugs are either injected or taken orally. Because the drugs are in the patient's bloodstream, they travel throughout the body to attack cancer cells wherever they may be. While chemotherapy can't cure prostate cancer, it can often slow it down -- prolonging a patient's life and easing his symptoms.

Whatever approach your doctor recommends, be sure to ask about the potential risks and benefits. And be sure to stay positive. With so many options available, most patients have a good chance of beating their disease.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

References

First published March 25, 2002
Last updated November 30, 2006
Copyright © 2002 Consumer Health Interactive

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