If you are diagnosed with prostate cancer, there are multiple factors which determine your treatment options. These include your PSA level, whether or not abnormalities are felt on your prostate, the amount of prostate cancer present in your biopsy, and the Gleason score, which is a measure of the aggressiveness of the prostate cancer. Multiple scoring systems have been created, using these variables, to determine your prostate cancer risk category. Your risk category determines which treatments are best for you.
For men that have low risk prostate cancer, many advocate for the strategy of active surveillance. This involves undergoing a PSA test and prostate examination every 3 months. Also, to confirm the original biopsy findings, the prostate biopsy is repeated, typically at one year. The idea is that as long as the prostate cancer is stable, there is no need for treatment. Remember that the majority of men with prostate cancer will die with it, not from it. Only if the prostate cancer becomes more aggressive does one proceed to curative therapy. For this strategy to succeed, a man needs to be comfortable not undergoing immediate treatment, and be diligent about making all of his appointments.
Men harboring intermediate risk prostate cancer are recommended to undergo treatment with intent to cure. Options include surgical prostate removal, known as prostatectomy, or destruction of the cancer by radiation therapy. In general, it is believed that the chance of cure using either radiation or surgery is equivalent.
Prostatectomy requires a hospital stay, and has all of the risks of undergoing major surgery. The advantage of prostatectomy is that the prostate is thoroughly evaluated after removal to determine if the cancer has migrated into the surrounding areas. In addition, way stations for cancers, called lymph nodes, are also removed at the time of surgery, providing additional information regarding whether or not the cancer may have spread. The side effects specific to prostate cancer surgery include urinary incontinence and trouble with erections. A majority of prostates removed in this country are now done using minimally invasive techniques, with the aid of a robot.
Radiation therapy for prostate cancer can occur with the entire radiation dose given at once, called brachy- or seed therapy, or the radiation dose given in small amounts during the course of many weeks, called IMRT. For more advanced prostate cancer, both IMRT and brachytherapy are sometimes combined. While avoiding major surgery, problems with urination and erections can still occur, in addition to irritation of the rectum and bladder, leading to urinary and fecal urgency, bleeding, and discomfort.
Men with high risk cancer are a special case. This will be discussed in detail in next week’s blog.
As with everything having to do with prostate cancer, there is no straight-forward answer. We at Sound Urological Associates would be happy to discuss these issues with you in further detail. Please call to schedule an appointment at (425) 775-7166.