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This information represents
the views of the doctors and nurses serving on the American Cancer
Society's Cancer Information Database Editorial Board. These views are
based on their interpretation of studies published in medical journals,
as well as their own professional experience.
The treatment information
in this document is not official policy of the Society and is not
intended as medical advice to replace the expertise and judgment of
your cancer care team. It is intended to help you and your family make
informed decisions, together with your doctor.
Your doctor may have
reasons for suggesting a treatment plan different from these general
treatment options. Don't hesitate to ask him or her questions about
your treatment options.
Some general comments about treatment
There is a lot for you to think about when choosing the best
way to treat or manage your cancer. There may be more than one
treatment to choose from. You may feel that you need to make a decision
quickly. But give yourself time to take in all the information you have
learned. Talk to your doctor. Look at the list of questions at the end
of this article to get some ideas. Then add your own.
The treatment you choose for prostate cancer should take into
account:
- your age and how long you can expect to live
- any other serious health problems you may have
- the stage and grade of your cancer
- your feelings (and your doctor's opinion) about the need to
treat the cancer
- the chance that each type of treatment will cure your
cancer (or provide some other measure of benefit)
- your feelings about the side effects common with each
treatment
You may want to get a second opinion, especially if you have
several treatments to choose from. Prostate cancer is a complex
disease, and doctors may differ in their opinions about the best
treatment options. Talking with doctors who specialize in different
kinds of treatment may be helpful. You will want to weigh the benefits
of each treatment against its drawbacks, side effects, and risks.
Watchful waiting (expectant management)
Because prostate cancer often grows very slowly, some men
(especially those who are older or who have other major health
problems) may never need treatment for their cancer. Instead, their
doctor may suggest an approach called watchful waiting (also called
expectant management).
This approach involves closely watching the cancer (with PSA
testing) without using treatment such as surgery or radiation therapy.
It may be a good option if the cancer is not causing any symptoms, will
probably grow slowly, and is small and contained in one place in the
prostate. It is less often a choice if you are younger, healthy, and
have a fast-growing cancer.
At this time, watchful waiting is a reasonable option for some
men with slow-growing
cancers because it is not known whether active treatment helps them to
live longer. Some men choose watchful waiting because, in their view,
the side effects of strong treatments outweigh the benefits. Others are
willing to accept the possible side effects of active treatments in
order to try to remove or destroy the cancer.
Watchful waiting does not mean your cancer will be ignored.
Rather, your doctor will watch what is going on. You will most likely
have a PSA blood test and DRE every 3 to 6 months, maybe with a yearly
biopsy of the prostate. If you start to have symptoms or if your cancer
begins to grow more quickly, you can think about active treatment. A
possible downside of this approach is that there's a chance it could
allow the cancer to become more advanced, which might limit your
treatment options.
Surgery
The most common operations for prostate cancer are radical
prostatectomy and transurethral resection of the prostate (TURP). Each
is explained in more detail below.
Radical prostatectomy
This surgery is done to try to cure the cancer. It is done
most often if it looks like the cancer has not spread outside the
prostate. The entire prostate gland and some tissue around it are
removed.
There are 2 main types of radical prostatectomy:
Radical
retropubic prostatectomy: This is the approach used by
most surgeons. The cut (incision) is made in the lower belly (abdomen),
as shown in the picture below. You will either be in a deep sleep
(under general anesthesia) or be given medicine to numb the lower half
of the body (an epidural) along with drugs to make you sleepy
(sedation).
Your doctor may first remove lymph nodes near the prostate and
have them looked at under a microscope. If any of the nodes contain
cancer, it means the cancer has spread. Since the cancer probably can't
be cured by taking out the prostate, the doctor may stop the operation.
The nerves that control erections are very close to the
prostate. During this operation, it is sometimes possible to avoid
harming these nerves (called a nerve-sparing approach). This lowers,
but does not do away with, the risk of impotence (being unable to have
an erection) after surgery. If you were able to have erections before,
the doctor will try not to injure these nerves. Of course, if the
cancer is growing into them, the doctor will have to remove them. Even
if the nerves have been spared, it takes at least a few months after
surgery to have an erection. This is because the nerves have been
handled during the operation and won't work properly for a while.
Radical perineal
approach: In the perineal approach, the surgeon makes the
cut (incision) in the skin between the anus and the scrotum, as shown
in the picture below. Nerve-sparing operations are harder to do with
the perineal approach, and lymph nodes cannot be removed. Still, the
surgeon can remove some lymph nodes another way, if needed. Because
this operation is often shorter, it might be used for men who don't
need the nerve-sparing procedure or who have other medical problems
that make the first approach harder.
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| Retropubic approach |
Perineal approach |
These operations last from 1 1/2 to 4 hours. The perineal
approach often takes less time than the retropubic approach. They are
followed by an average hospital stay of 3 days. The average time away
from work is 3 to 5 weeks.
In most cases, you will be able to donate your own blood
before surgery. The blood can be given back to you during the
operation, if needed. Usually a tube for draining urine (called a
catheter) is put into the bladder through the penis after surgery,
while you are still asleep. The catheter stays in for 1 to 3 weeks and
allows you to pass urine easily while you are healing. You will be able
to urinate on your own after the catheter is removed.
Laparoscopic
radical prostatectomy (LRP): Both of the
operations described above use an "open" approach in which the surgeon
makes a long cut (incision) to remove the prostate. A newer method
involves making several smaller cuts and using special long instruments
to remove the prostate. It is called laparoscopic radical prostatectomy
or LRP and is being used more and more in this country.
LRP has advantages over the open approach: less blood loss and
pain, shorter hospital stays, and faster recovery time. Nerve-sparing
is possible with LRP, and the side effects seem to be about the same as
for open prostatectomy.
LRP has been used in the United States since 1999. It is done
in community and university centers. Because it is still somewhat new,
results of long-term studies are not in yet. If you are thinking about
treatment with LRP, find out as much as you can about this approach.
Also be sure to find a surgeon with a lot of experience doing LRP.
Robotic-assisted
laparoscopic radical prostatectomy: An even
newer approach is to do LRP remotely using a robotic interface. The
surgeon sits at a panel near the operating table and controls robotic
arms to do the operation through several small cuts (incisions) in the
patient's belly (abdomen). For the patient, there is little difference
between direct and remote (robotic) LRP, either during surgery or
recovery.
Robotic LRP has been in use for only a few years in the United
States. The machines themselves are expensive, and are found in only a
few medical centers across the country. Still, this approach has become
more popular in recent years. Again, the most important factors are
likely to be the skill and experience of your surgeon.
Transurethral
resection of the prostate (TURP): This procedure
is done to relieve symptoms, such as trouble passing urine, in men who
can't have other types of surgery. It is not done to cure the disease
or to remove all the cancer. The same operation is used even more often
to relieve symptoms of non-cancerous prostate swelling called BPH.
During this operation, a tool with a small loop of wire on the
end is placed through the end of the penis into the urethra. The wire
is heated and cuts out the part of the prostate that is pressing in on
the urethra. No cut (incision) is needed for TURP. Either spinal
anesthesia, where you are made numb from the waist down, or general
anesthesia, which outs you into a deep sleep, is used.
The operation takes about an hour. You can usually leave the
hospital after 1 to 2 days and go back to work in 1 to 2 weeks. After
surgery you will need a tube for draining urine (called a catheter) for
about 2 or 3 days. There may be some blood in your urine for a short
time after surgery.
Risks and side effects of radical
prostatectomy
There are possible risks and side effects with any type of
surgery for prostate cancer.
Surgical risks
The risks with this surgery are like those of any major
surgery. They can include problems from the anesthesia, a small risk of
heart attack, stroke, blood clots in the legs, infection, and bleeding.
Your risk depends, in part, on your overall health, your age, and the
skill of your doctors.
Side effects
The main possible side effects of radical prostatectomy are
lack of bladder control (incontinence) and not being able to get an
erection (impotence). These side effects can also happen with other
kinds of treatment but they are described here in more detail.
Urinary
incontinence: Incontinence means you can't control
your urine or you have trouble with leaking. There are different types
of incontinence. Having this problem can affect you not only physically
but emotionally, too.
There are 3 types of incontinence:
- Stress
incontinence is the most common type of
incontinence after prostate surgery. Men with stress incontinence leak
urine when they cough, laugh, sneeze, or exercise. Stress incontinence
is the most common type of incontinence after prostate surgery.
- Men with overflow
incontinence take a long time to
urinate and have a dribbling stream with little force.
- Men with urge
incontinence have a sudden need to go
to the bathroom and pass urine.
In rare cases, men lose all ability to control their urine.
This is called continuous
incontinence.
Normal bladder control returns for many men within several
weeks or months after the operation. Doctors can't predict how any one
man will function after surgery.
Most large cancer centers, where this surgery is done more
often and surgeons have more experience, report fewer problems with
incontinence. If you have problems with incontinence, let your doctors
know. Doctors who treat men with prostate cancer should know about
incontinence, and should be able to suggest ways to help you. There are
exercises (Kegel exercises) you can learn that might help to strengthen
your bladder. There are medicines or even surgery that might help.
There are also products to help keep you dry and comfortable.
Impotence:
Impotence means that a man can't get an erection
strong enough to have sex. The nerves that allow men to get erections
may be damaged during surgery, radiation treatment, or other
treatments. During the first 3 to12 months after surgery, you will
probably not be able to get an erection without using medicine or some
other treatment. Later, some men will be able to get an erection and
some will still have trouble. Whether or not you will be able to get an
erection depends on your age and the type of surgery that was done. The
younger you are, the more likely you will still be able to get an
erection. If you are able to get an erection the feeling of pleasure
(orgasm) during sex will still be there. The orgasm will be "dry,"
though, since semen is not being made.
If you are concerned about erection problems, be sure and talk
to your doctor. There are ways to help. There are medicines and even
devices such as vacuum pumps and penile implants that could prove
useful. For more information to help you understand and cope with the
sexual side effects of prostate cancer treatment, please see Sexuality
and Cancer: For the Man Who Has Cancer and His Partner.
You can order
it through our toll-free number or find it on our Web site.
Sterility: A
radical prostatectomy cuts the tubes between the
testicles (where sperm are made) and the urethra. This means that a man
can no longer father a child by natural means. Often this is not an
issue as men with prostate cancer tend to be older. But if this is a
concern for you, talk to your doctor about "banking" your sperm before
the operation.
Lymphedema: A
rare side effect of removing many of the lymph
nodes around the prostate is lymphedema, which causes swelling and
pain. Lymph nodes provide a way for fluid to return from all around the
body to the heart. When the nodes are removed, fluid can collect in the
legs or genital region. Lymphedema can often be treated with physical
therapy, but it might not go away completely.
Change in penis
length: Another possible side effect of
surgery is a decrease in penis length.
Radiation therapy
Radiation therapy is treatment with high-energy rays (such as
x-rays) to kill or shrink cancer cells. The radiation may come from
outside the body (external radiation) or from radioactive materials
placed directly in the tumor (brachytherapy or internal radiation).
Radiation is sometimes used as the first treatment for
low-grade cancer that has not spread outside the prostate gland, or has
spread only to nearby tissue. It is also sometimes used if the cancer
is not completely removed or comes back (recurs) in the area of the
prostate after surgery. Cure rates for men treated with radiation seem
to be about the same as for men having surgery. If the cancer is more
advanced, radiation may be used to shrink the tumor and provide pain
relief.
External beam radiation therapy (EBRT)
This treatment is much like getting a regular x-ray, but for a
longer time. Each treatment lasts only a few minutes. Men usually have
5 treatments per week in an outpatient center over a period of 7 to 9
weeks. The treatment itself is quick and painless.
Today standard EBRT is used much less often than in the past.
Newer techniques allow doctors to be more accurate in treating the
prostate gland while reducing the radiation exposure to nearby healthy
tissues. These techniques appear to offer better chances of increasing
the success rate and reducing side effects. If you are having one of
the newer methods, your doctor can tell you more about it.
Possible side effects of external beam
radiation therapy
The possible side effects below relate to standard external
radiation therapy, which is now used much less often than in the past.
The risks of the newer treatment methods mentioned above are likely to
be lower.
Bowel problems:
During and after treatment with external beam
radiation therapy, you may have diarrhea, sometimes with blood in the
stool, rectal leakage, and an irritated large intestine. Most of these
problems go away over time, but in rare cases normal bowel function
does not return after treatment ends.
Bladder problems:
You might find yourself needing to urinate
more often, have burning while passing urine, and maybe see blood in
your urine. Bladder problems last in about 1 out of 3 patients, with
the most common problem being the need to urinate often.
Urinary
incontinence: Incontinence means you can't control
your urine or you have trouble with leaking. Although this side effect
is less common than after surgery, the chance of incontinence goes up
each year for several years after treatment. For more information, see
the above section on incontinence under the surgery side effects.
Impotence:
Impotence means that a man can't get an erection
strong enough to have sex. After several years, the impotence rate
after radiation is about the same as that of surgery. It usually does
not happen right after radiation therapy, but slowly develops over a
year or more. As with surgery, the older you are, the more likely it is
you will become impotent. Impotence may be helped by treatments such as
those listed in the surgery section above, including erectile
dysfunction medicines.
Feeling tired:
Radiation therapy may also cause severe
tiredness called fatigue. It may not go away until a few months after
treatment stops.
Lymphedema:
Fluid buildup in the legs or genitals (described
in the surgery section of this document) is possible if the lymph nodes
receive radiation.
Brachytherapy (internal radiation)
Permanent or
low dose brachytherapy uses small radioactive
pellets (each about the size of a grain of rice) that are put into the
prostate. Sometimes these pellets are referred to as "seeds." Because
they are so small, they cause little discomfort and are often left in
place after their radioactive material is used up.
Another form of brachytherapy is called temporary or high dose
brachytherapy. In this type, needles are used to place
soft tubes
(catheters) in the prostate. A strong radioactive substance is placed
in these catheters for 5 to 15 minutes and then taken out. You will
stay in the hospital for this treatment. Usually 3 treatments are given
over a couple of days. After the last treatment the catheters are
removed. Often this treatment is combined with external radiation,
given at a lower dose than it would be if used alone. For about a week
after this treatment you may have some pain in the area between your
scrotum and rectum, and your urine may be reddish-brown.
Possible risks and side effects of
brachytherapy
If you have pellets that are left in place, they will give off
small amounts of radiation for several weeks. Even though the radiation
doesn't travel far, you may be told to stay away from pregnant women
and small children during this time. You may be asked to be careful in
other ways, too, such as wearing a condom during sex.
For about a week after the pellets are put in place, there may
be some pain in the area and a red-brown color to the urine. There is
also a small risk that some of the seeds might move to other parts of
the body, but this is rare. Like external radiation treatment, this
approach can have side effects such as problems with the bladder and
bowel and impotence. Talk to your doctor if you have any problems.
Often there are medicines or other methods to help.
Cryosurgery
Cryosurgery is sometimes used to treat prostate cancer by
freezing the cells with cold metal probes. It is used only for prostate
cancer that has not spread, but may not be a good option for men with
large prostate glands. The probes are placed through cuts (incisions)
between the anus and the scrotum. Cold gases are then passed through
the probes, which creates ice balls that destroy the prostate gland.
Some type of anesthesia is used during this procedure.
A catheter is also put in place (usually through the belly) so
that when the prostate swells (it usually does after this treatment)
urine does not stay trapped in the bladder. You will probably be in the
hospital for a day. The catheter is removed a couple of weeks later.
After the procedure, there will be some bruising and soreness of the
area where the probe was inserted. You may have some blood in the urine
for the first few days. Short-term swelling of the penis and scrotum
after cryosurgery is also common.
Possible side effects of cryosurgery
There are benefits and drawbacks to cryosurgery. Because it is
less invasive than radical surgery, there is less loss of blood, a
shorter hospital stay, shorter recovery time, and less pain. But
freezing can damage nerves near the prostate and cause impotence and
incontinence. These side effects may occur more often than they do
after radical prostatectomy. Freezing may also damage the bladder and
intestines. This can cause pain, a burning sensation, and the need to
empty the bladder and bowels often.
Compared to surgery or radiation treatment, doctors know much
less about how well this method works in the long run. For this reason,
most doctors do not include cryosurgery among the first options they
recommend for treating prostate cancer.
Hormone therapy
The goal of hormone therapy (also called androgen deprivation)
is to lower the levels of the male hormones or androgens, such as
testosterone. Androgens, which are made mostly in the testicles, cause
prostate cancer cells to grow. Lowering androgen levels often makes
prostate cancer shrink or grow more slowly. Hormone therapy can
control, but will not cure the cancer. It is not a substitute for
treatments aimed at a cure.
Hormone therapy is often used in the following situations:
- In men who do not have surgery or radiation as good
treatment options.
- For men whose cancer has spread to other parts of
the body or has come back after earlier treatment.
- It may be used along with radiation in men who are
at high risk of having the cancer return after treatment.
- Sometimes it is used before surgery or radiation to
shrink the cancer.
While hormone therapy does not cure the cancer, it can provide
relief from symptoms. Some doctors think that hormone therapy works
better if it is started as early as possible after the cancer has
reached an advanced stage. But not all doctors agree with this.
Because nearly all prostate cancers become resistant to
hormone therapy over time, some doctors use an on-again, off-again
approach (this is called intermittent therapy). The drugs are given for
a while, then stopped, then started again. One advantage is that some
men are able to avoid the side effects (impotence, loss of sex drive,
etc.) for a time. Studies are now going on to see whether this new
approach is better or worse than giving the drugs non-stop.
Types of hormone therapy
There are several types of hormone therapy. They involve
either surgery or the use of drugs to lower the amount of testosterone
or to block the body's ability to use androgens.
Orchiectomy:
Even though this is a type of surgery, its main
effect is as a form of hormone therapy. In this operation, the surgeon
removes the testicles, where more than 90% of the androgens, mostly
testosterone, are made. While this is a fairly simple procedure and is
not as costly as some other options, it is permanent and many men have
trouble accepting this operation. Most men who have this surgery lose
the desire for sex and cannot have erections.
LHRH analogs
(luteinizing hormone-releasing analogs): These
drugs lower testosterone levels just as well as orchiectomy. LHRH
analogs (or agonists) are given as shots, either monthly or every 3, 4,
6, or 12 months. Even though this treatment costs more and means more
doctor visits, most men choose this method over surgery to remove the
testicles.
When LHRH analogs are the first given, the testosterone level
goes up briefly before going down to low levels. This is called
"flare." Men whose cancer has spread to the bones may have bone pain
during this flare. To reduce flare, drugs called anti-androgens can be
given for a few weeks before starting treatment with LHRH analogs.
LHRH antagonists:
A newer drug, abarelix (Plenaxis) is an LHRH
antagonist. It lowers testosterone more quickly and does not cause a
flare. But a small number of men are allergic to this drug. For this
reason it is only used for men who cannot take other forms of hormone
therapy.
Abarelix is given only in certain doctors' offices. It is
given as a shot every 2 weeks for the first month, then every 4 weeks.
You will need to stay in the office for 30 minutes after the shot to
make sure you do not have an allergic reaction.
Anti-androgens:
These drugs block the body's ability to use
any androgens. Even after the testicles are removed or during LHRH
treatment, the adrenal glands still make a small amount of androgens.
Anti-androgens may be used along with orchiectomy or the LHRH analogs
to provide combined
androgen blockade (CAB), or total blocking of all
androgens produced by the body. There is still debate about whether CAB
is better than using the other treatments alone.
Other drugs: At
one time estrogens (female hormones) were used
to treat men with prostate cancer. Because of side effects, LHRH
analogs and anti-androgens are now used. But estrogen or some other
drugs, such as ketoconazole (Nizoral), may be used if other hormone
treatments are no longer working.
Side effects of hormone therapy
Orchiectomy, LHRH analogs, and LHRH antagonists all cause side
effects because of changes in the levels of hormones. These side
effects can include:
- less sexual desire
- impotence (inability to get an erection)
- hot flashes (these may get better or even go away
with time)
- breast tenderness and growth of breast tissue
- bone thinning (osteoporosis) which can lead to
broken bones
- low red blood cell counts (anemia)
- decreased mental sharpness
- loss of muscle mass
- weight gain
- extreme tiredness (fatigue)
- increased cholesterol
- depression
The risk of high blood pressure, diabetes, and heart attacks
is also higher in men treated with hormone therapy.
Many side effects can be prevented or treated. For example,
hot flashes can be helped by treatment with certain antidepressants.
Brief radiation treatment to the breasts can help prevent their
enlargement. There are drugs available to prevent and treat
osteoporosis. Depression can be treated by antidepressants or
counseling. Exercise can help reduce many side effects, including
fatigue, weight gain, and the chance of loss of bone and muscle mass.
If anemia occurs, it is often very mild and usually doesn't cause
symptoms.
There is growing concern that hormone therapy for prostate
cancer may lead to problems with thinking, concentration, or memory.
But this link has not been studied well in men getting hormone therapy
for prostate cancer. Different studies have shown changes in different
types of memory. Some have even found that while some types of memory
get worse, another type got better. Other studies found no effect at
all. More studies are being done to look at this issue.
Debates about hormone therapy
Many issues about hormone therapy are not yet resolved, such
as the best time to start and stop it and the best way to give it.
Studies looking at these issues are now going on. If you are thinking
about hormone therapy, ask your doctor to explain which treatments will
be used and what side effects you might expect to have.
Chemotherapy (Chemo)
Chemo is the use of drugs to treat cancer. The drugs are often
injected into a vein. Some can be swallowed in pill form. Once the
drugs enter the bloodstream, they spread throughout the body to reach
and destroy the cancer cells.
Chemo is sometimes used if prostate cancer has spread outside
of the prostate gland and hormone therapy isn't working. It is not a
standard treatment for early prostate cancer, but some studies are
looking to see if chemo could be helpful if given for a short time
after surgery.
Like hormone therapy, chemo is unlikely to result in a cure.
This treatment is not expected to destroy all the cancer cells, but it
may slow the cancer's growth and reduce symptoms, resulting in a better
quality of life.
There are many different chemo drugs. Often 2 or more are
given at the same time for better effect.
Side effects of chemo
While chemo drugs kill cancer cells, they also damage some
normal cells and this can lead to side effects. The side effects of
chemo depend on the type of drugs, the amount taken, and the length of
treatment. They could include:
- nausea and vomiting
- loss of appetite
- hair loss
- mouth sores
Because normal cells are also damaged, you may have low blood
cell counts. This can cause:
- increased risk of infection (from a shortage of
white blood cells)
- bleeding or bruising after minor cuts or injuries
(from a shortage of blood platelets)
- tiredness (from low red blood cell counts)
Also, each drug may have its own unique side effects.
Most side effects go away once treatment is over. If you have
problems with side effects, talk with your doctor or nurse about what
can be done. There is help for many chemo side effects. For example,
there are drugs to prevent or reduce nausea and vomiting. Other drugs
can be given to boost blood cell counts.
Treating pain and other symptoms
Most of this article talks about ways to remove or destroy
cancer cells or to slow their growth. But it is important to know that
having a good quality of life is also an important goal. Be sure to
talk to your doctor or nurse about pain or any symptoms that are
bothering you. There are ways to treat these. And getting good
treatment can help you feel better and allow you to focus on things
that are important in your life.
Pain medicines
Pain medicines work very well. When the drugs are being used
as directed to treat cancer pain, you do not need to worry about
addiction or dependence. Symptoms such as drowsiness and itching may
occur, but usually go away after you get used to the medicine.
Constipation may be a problem, but there are things you can do to
prevent this. Side effects can often be managed by changing the dosage
or by adding other medicines.
Bisphosphonates
This is a group of drugs that can help relieve bone pain. They
may also slow the growth of the cancer cells and strengthen bones in
men who are getting hormone treatment.
Bisphosphonates can cause side effects, such as flu-like
symptoms and bone pain. Some men have had a very rare, but distressing
side effect from these drugs. They have pain in the jaw and their
doctors find that part of the jaw bone has died. This can lead to loss
of teeth or infections of the jaw bone. Doctors don't know why some
people develop these jaw problems or how to prevent them. So far, the
only treatment has been to stop the bisphosphonate treatment. Some
cancer doctors recommend that patients have a dental check-up and have
any tooth or jaw problems treated before they start taking
bisphosphonates.
Steroids
Sometimes steroids can relieve bone pain and increase appetite
for some men.
Radiation therapy
While radiation therapy can be used as the main treatment for
prostate cancer, it can also be used to treat bone pain caused by
cancer that has spread to the bone.
Drugs called radiopharmaceuticals
are also used for this
purpose. This is a group of drugs that have radioactive elements. They
are given into a vein. They settle in areas of bones that contain
cancer and the radioactive part kills the cancer cells there. About 8
out of 10 prostate cancer patients with bone pain are helped by this
treatment. The main side effect is a lowering of blood cell counts.
This could increase your risk of getting an infection or bleeding
easily.
What is the best treatment for me?
If you have prostate cancer, you will want to think about a
lot of things before you choose a course of treatment. These things
include your age, your overall health, your goals for treatment, and
your feelings about side effects. Some men, for example, can't imagine
living with side effects such as incontinence or impotence. Others are
less concerned about these and more concerned about getting rid of the
cancer.
If you are over 70 or have serious health problems, you might
want to think of prostate cancer as a chronic disease. It will most
likely not lead to your death. But it could cause symptoms you want to
avoid. In this view, the goal is to relieve symptoms and avoid side
effects of treatment. So you might decide to choose watchful waiting or
hormone therapy. Of course, age itself is not the best basis on which
to make your choice. Many men are in good mental and physical shape at
age 70, while some younger men may not be as healthy.
If you are younger and otherwise healthy, you might be more
willing to put up with the side effects of treatment if they offer you
the best chance for cure. Most doctors now feel that external
radiation, radical prostatectomy, and radioactive implants have the
same cure rates for the earliest stage prostate cancers. But each man's
situation is unique and is influenced by many factors.
These decisions are even harder for you if you try to make
them alone. It is often helpful to discuss treatment options with more
than one doctor. It's natural for surgical specialists, such as
urologists, to recommend surgery, and for radiation oncologists to
recommend radiation. You may want to consider getting more than one
medical opinion, perhaps even from different types of doctors. Your
primary care doctor can often help you sort out which treatment plan is
best for you.
Many men find it helps to talk to others who have faced the
same issues. The American Cancer Society's Man to Man program (or
programs like this offered by other organizations) provides a way for
men to meet and talk about issues related to prostate cancer. To learn
more about Man
to Man, please call our toll-free number or visit our Web
site.
Last Medical Review: 09/26/2008 Last Revised: 11/12/2008
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