Treatment choices

After a prostate cancer diagnosis, one of the “aftershocks” for most men is that they must make the decision on which treatment to pursue. With every prostate cancer patient, there are many different variables – age, stage of cancer, lifestyle choices and risks – all which needs to be weighed against a smorgasbord of treatment options and differing recommendations from physicians. It can be very confusing, and frightening for men without medical degrees. Ultimately, every new patient needs to do their homework and consider all their options carefully.

The Big Two: Surgery or Radiation

The main entrees on the menu – surgery vs. radiation. There are flavors of each.
What many men learn quickly is that the medical community cannot tell them which treatment – surgery or radiation – gives them their best shot for survival. Urologists are biased toward surgery, radiologists want to radiate it; but neither can brag of a superior cure rate. Because there’s no consensus ‘gold standard’ therapy for prostate cancer, it’s often left up to the patient to choose.

The Menu of Options

Here are some of the treatment options that medical science now offers to prostate cancer patients. Again, there are others beyond this list, so do the homework before choosing:

Watchful waiting is an option, generally, for men in which prostate cancer grows very slowly. This is a euphemism for doing nothing, except monitoring your situation. Men over 75 years of age often make good candidates for watchful waiting, because their cancer is generally slow to grow and rather harmless. By choosing a path of watchful waiting, you would not undergo any active treatment. No medications, no radiation, no surgery. Instead, your doctor monitors your prostate cancer with regular PSA tests and digital rectal examinations. These tests keep an eye out for changes that signal your prostate cancer is growing more quickly, which might call for aggressive therapy.

‘Nerve-sparing’ open radical prostectomy is where surgeons cut around the sensitive nerve bundles that cling to the sides of the prostate – all part of a guy’s delicate sexual apparatus. A somewhat bloody operation, it requires anesthesia, at least a five-day hospital stay, and maybe two weeks wearing a catheter to pee.

Da Vinci robotic surgery is where a machine actually performs the surgery while a surgeon remotely operates the machine. The idea is that by making smaller incisions and working with finer tools, the robot can do better than a surgeon in removing the prostate and minimizing the collateral damage. A high level of skill is generally required, and directly relates to successful outcomes.

High-dose radiation therapy, such Image-Guided Radiation Therapy, is one of the latest technologies for delivering high-dose radiation to the prostate with uncanny accuracy. Beams of radiation precisely conform to the shape of the prostate, minimizing radiation to healthy tissues surrounding the prostate and, therefore, many side effects like incontinence and impotency.

Brachytherapy is where permanent radioactive “seeds” – the size of a grain of rice – are strategically implanted into the prostate, each radiating a bubble of death to malignant cells. It’s a few days of outpatient procedures, no extended hospital stay. No cutting. No catheters. No drugs to kill the post-procedure pain. 

Proton beam therapy, a form of targeted external beam radiation, is also gaining in popularity. The attraction is that protons, unlike X-rays, pass through healthy tissues with little damage and destroy only tumor cells in their path. In theory, proton therapy not only reduces side effects, but it saves more lives. Critics say proton therapy is exorbitantly costly, and, to recover the cost of investing in the technology, providers could be over-treating elderly men who'd be better served by watchful waiting. That criticism, by the way, applies to expensive high-dose radiation therapies as well.

Androgen deprivation therapy blocks production of testosterone. Generally, ADT is an adjunct therapy for men with advance-staged prostate cancer.

Crytotherapy freezes the prostate and kills malignant clusters.

Best advice
Do lots of homework and don’t jump at the first option presented, even by a trusted physician. Every man should understand all his options and choose the one best suited for him, based on age, cancer stage, and risk tolerance for potential lifestyle side effects.