All cancer diagnoses are unsettling and all patients will have questions they need answers to. Men diagnosed with prostate cancer are no different. Even though prostate cancer has a 98 percent survival rate, men should take the diagnosis seriously. Asking questions is important and expected by all doctors who treat cancer. By becoming well-educated on understanding this disease, the better decisions they will for the best outcome.
One of the most important questions men can ask is how their prostate cancer will be treated. Today, there are many options for treating prostate cancer than in the past. Improvements have been made reducing side effects along with treatment outcomes enhancing a man’s chance for surviving this disease. Whichever treatment option is ultimately decided on, will be determined by the stage of the cancer, the type, and location of the disease.
Here are five questions regarding treatment options all men with prostate cancer should inquire about. All men with prostate cancer are unique and not all treatment options are right for every man. As men gather their information, they, along with their doctor’s recommendations, can decide upon the best treatment option for them:
1. Is Active Surveillance right for me?
A diagnosis of any type of cancer is scary with a natural reaction to get the cancer out as soon as possible. Men diagnosed with prostate cancer will usually have this same response but not all prostate cancers are the same – some will be very aggressive and more likely to spread to other areas of the body. If the prostate cancer is contained to just the prostate, it may grow so slowly posing minimal threat.
That’s why prostate cancer found to be growing very slowly, may never need to be treated. Instead, a treatment option called active surveillance is an approach a doctor may recommend instead. This approach may be recommended for men with:
- A small tumor that is confined to the prostate
- A slow-growing type of prostate cancer
- A cancer that is at low risk of growing locally or spreading
Active surveillance means to monitor the cancer closely by having a prostate specific antigen blood test (PSA) and a digital rectal exam either every six months or yearly. Watchful waiting is another term some doctors’ use and may mean a less intensive type of follow-up relying on fewer tests and relying more on changes in a man’s symptoms deciding then if treatment is needed.
2. Am I a candidate for surgery?
Prostatectomy is the gold standard for men with prostate cancer whose life expectancy is greater than ten years and whose cancer is contained within the prostate and has not spread to the bone. It’s also recommended for men in overall good health and for men under the age of 70.
This procedure involves removing the entire prostate gland. It is a complex operation that takes place in a densely packed part of the male anatomy, but it’s one that skilled surgeons do successfully every day. Its goal is to leave the patient cancer-free and restore his former lifestyle, which means sparing the nerves that control urinary and sexual function.
There are three different possible types of surgery with various pros and cons:
Open prostatectomy, is a more traditional surgical procedure in which an abdominal incision is made slightly below the navel. Depending on a man’s PSA level, lymph nodes may be removed. This surgery will remove the cancerous tumor but a man will have limited activity for up to five or more weeks.
Laparoscopic prostatectomy is another minimally invasive procedure following the same principles as open surgery, but the surgeon’s hands never enter the body. Several small incisions are made and the prostate is removed by using special medical instruments. There is minimal blood loss, less pain, faster recovery, and a shorter hospital stay.
Robotic radical prostatectomy is a minimally invasive procedure combining the advantages of the open and laparoscopic approaches. A trained and skilled surgeon used a computer-enhanced robotic surgical system. This surgery makes tiny incisions with little or no blood loss, less pain, shorter recovery and hospital stay (one to two days), and better preservation of urinary and sexual function.
3. Is radiation used to treat prostate cancer?
Radiation can be used alone or in combination with hormonal treatment for treating prostate cancer. Radiation is sometimes used after prostate cancer surgery as another option to destroy any remaining cancer cells and to relive pain from metastatic cancer. Using radiation is most effective when the cancer has not spread beyond the prostate even though it can still be used if the cancer has spread to other nearby tissue.
Radiation therapy uses high doses of radiation to destroy cancer cells. During the process the radiation damages the genetic material of the cells making it impossible for them to grow. Normal, healthy tissue can be damaged during radiation but normal cells can generally repair themselves and return to functioning whereas cancer cells cannot.
Candidates for radiation include:
- Cancer that has not spread in generally healthy men younger than 70.
- Cancer that has not spread to the bones, is not getting better with hormonal treatment, and is causing pain.
- Cancer that has come back in the prostate after surgery
One thing men should know is that surgery after radiation is challenging if not impossible. Radiated tissue can become almost like cement that can attach to the rectum and surrounding tissue. This significantly increases the risk of incontinence and erectile dysfunction.
4. Is hormone therapy a good option?
Male hormones, like testosterone, can fuel the growth of prostate cancer. Hormone therapy is designed to reduce the body’s levels of androgens and is called androgen deprivation therapy or ADT. It is used to fight prostate cancer by shrinking the tumor. ADT can be considered as a treatment option in the following situations:
- When the cancer has spread or metastasized beyond the prostate
- When the cancer is confined to the prostate and hormone therapy can be used to boost the effectiveness of radiation therapy or to shrink the size of a tumor before brachytherapy.
- When a man’s prostate specific antigen (PSA) begins to rise sometime after initial treatment with surgery or radiation therapy, indicating the cancer may have recurred.
There can be side effects from the use of hormone therapy a man may experience which include the following:
- Hot flashes
- Reduced libido
- Erectile dysfunction
- Gynecomastia – breast enlargement
- Weight gain, loss of muscle mass
- Fatigue, anemia
- Changes in blood cholesterol and blood glucose measurements
5. Can chemotherapy be a good option for treating prostate cancer?
Chemotherapy refers to any type of therapy that uses chemicals to kill or halt the growth of cancer cells. Typically, chemotherapy is not a common treatment for prostate cancer, particularly if the cancer is confined to the prostate gland. If the cancer has spread beyond the prostate and hormonal therapy has not been successful, chemotherapy may be considered. However, chemotherapy is unlikely to cure prostate cancer but it may provide some benefits to patients where it may be used:
- To relieve symptoms associated with very advanced or metastatic disease, improving the patient’s quality of life
- To improve the outcome of prostate cancer surgery if administered for a short time after the procedure
- To work in conjunction with hormone therapy and improve the patient outcome
- To prolong the life of a prostate cancer patient who no longer responds to hormone therapy
- To treat men with advanced prostate cancer who carry the AR-V7 gene variant
Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.