Prostate Cancer Awareness- Understanding Treatment Options

This question in itself comes as a big surprise to many men.  The idea that they have cancer, but not treating the cancer, runs counter to the widely held belief that doing something is always better than doing nothing.
In fact, most prostate cancers grow slowly; This has led to the investigation of ‘observational approaches’ to managing localized prostate cancer (cancer that has not spread outside of the prostate gland at the time of diagnosis).  Observation is also referred to as ‘watchful waiting‘ or ‘active surveillance.’
 

For men with localized prostate cancer who are not candidates for observation alone, or who aren’t comfortable with this approach, there are a number of options to treat their disease.  The most common treatments chosen by men in the US are surgery (nearly half of all men), followed closely by radiation treatment (about 40%).
 

The two most common complications of both surgery (prostatectomy) and radiation are sexual and urinary difficulties.  During prostatectomy, the bladder, urethra (the tube that carries urine), and the nerves that control erections can all be affected post-surgery.  This is because the bladder is next to the prostate gland, and the urethra and erection nerves run through the gland.
Radiation for prostate cancer can be delivered in different ways.  All of these treatment approaches are designed to kill cancer cells in the prostate and to minimize damage to the nearby bladder, urethra, and nerves that control erections, but damage to these structures remain a possibility. Regardless of which form of radiation treatment is chosen, the chances of these complications are similar to the rates seen after surgery.

Prostate surgery can be done in a number of different ways, but over the past 10 years, ‘robotic’ prostatectomy has become the most common approach and is now used for more than 80% of prostate removals in the U.S.  This procedure uses a mechanical arm and magnification system that is operated by the surgeon from a control panel set up in the operating room. This system allows the surgeon to have a better view of the prostate gland and surrounding structures and to remove the diseased gland; this is designed to decrease chances of causing harm to the adjacent normal tissues and organs.
 

Just as the use of robotic surgery has increased rapidly in recent years, there is a new method of radiation treatment called proton beam therapy that is growing dramatically. Instead of the photons used in traditional radiation treatments, proton beam therapy uses different sub-atomic particles (protons) that are designed to deliver a very high dose of radiation to the cancer cells but release very little radiation on the way to the tumor; the idea is that this limits the damage to normal surrounding tissues.  There is also no convincing evidence that complication rates are lower with proton therapy.
 

Hormone treatment, called androgen deprivation therapy or ‘ADT’, is sometimes used for localized cancer, usually in addition to radiation treatment. Other approaches approved to treat early stage prostate cancer in the US include cryotherapy, which kills cancer cells by freezing the prostate gland, and stereotactic body radiation therapy (SBRT, sometimes referred to as ‘cyberknife’ treatment), which is designed to deliver high doses of radiation to tumors. Only about 1 in 10 men currently choose these methods as the first choice to treat prostate cancer.