Prostate Cancer Treatment: Do Your Homework, Know Your Options

According to the American Cancer Society, prostate cancer is the most common cancer among men, after skin cancer, and an estimated 191,00 new cases will have been diagnosed by the end of 2020. When men are diagnosed with prostate cancer they have to make sense of treatment options presented to them. It is important that they fully understand the risks and side effects that come with each treatment so they can make an educated choice.

The vast majority of men diagnosed with prostate cancer have localized disease, defined as cancer that hasn’t spread outside of the walls of the prostate. For some patients, urologists may recommend active surveillance, or monitoring low grade disease with periodic prostate specific antigen (PSA) tests and biopsies of the prostate.

Two standard choices have dominated treatments – radical prostatectomy and/or radiation therapy. A minimally invasive procedure called high-intensity focused ultrasound (HIFU) has gained traction in the U.S. in the last five years and is known to reduce the risk of side effects of urinary incontinence and erectile dysfunction, often associated with surgery and radiation. HIFU is an appropriate alternative for prostate cancer patients who meet certain criteria.

In their quest for the best solution for themselves, men must absorb information from their urologist. They should also learn from the experience of their peers. Recently I spoke on a panel with three prostate cancer patients who each had different treatments: radical prostatectomy, radical prostatectomy and radiation therapy, and HIFU. The three men spoke frankly about their challenges and triumphs. Listening to discussions like theirs is one of the best ways to make an informed decision.

The following is an overview of these three treatment options, with potential risks and side effects.

Prostatectomy 

Prostatectomy is a surgical approach to treating prostate cancer involving the removal of the entire prostate and seminal vesicles. It requires a one-to-two night stay in a hospital and most procedures are performed using the robotic system.

Risks and side effects include:

• Urinary incontinence (inability to control the flow of urine from the bladder), which is usually temporary. It’s very hard to predict who will be affected by this complication, however older men are more likely to experience incontinence compared to younger patients.
• Erectile dysfunction is a common side effect. While ED is multifactorial, three factors appear to play a very important role in predicting post-surgery outcomes:
  • Age
  • Pre-operative erectile function
  • Whether a nerve-sparing approach can be performed.

Radiotherapy

Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation is common and can be used as a primary treatment or if the cancer comes back after surgical removal of the prostate. Cure rates for men with these types of cancers are similar to those for men treated with prostatectomy.

Risks and side effects are usually related to irritation to surrounding structures:

• Bowel problems such as radiation proctitis
• Urinary problems, including inflammation of the bladder (radiation cystitis)
• Erectile dysfunction

High Intensity Focused Ultrasound (HIFU) 

Focal HIFU is a noninvasive option for patients with localized prostate cancer. HIFU combines magnetic resonance imaging with ultrasound guided imaging to enable doctors to precisely target and destroy only the diseased portion of the prostate. By sparing the surrounding structures, focal HIFU minimizes the risk of urinary continence and erectile dysfunction.

Risks and side effects include:

• Short term catheter required following treatment
• Potential inability to ejaculate
• Need for continued monitoring of the remaining prostatic tissue

It is important that men take educating themselves seriously. Knowing the options allows patients to make more informed decisions, evaluate all possible treatment options and choose the one that allows them to maintain their highest quality of life.