Treatment Options for Prostate Cancer
While advances are made almost daily concerning the treatment of prostate cancer, treatment for prostate cancer depends on the stage of the disease (whether the disease is localised to the prostate or has spread), and the age and fitness of the patient.
Grading and staging of the disease
Prostate cancer has a wide range of behaviour - it may be a very slow-growing tumour, but in some men the tumours are relatively aggressive and grow rapidly. Prostate cancers can be graded using a prostate biopsy with reasonable accuracy. The grade of the cancer is judged between"1": well-differentiated and slow-growing, up to "5": poorly differentiated and rapidly growing.
If you are deemed to have a 10-15 year life expectancy (i.e. usually you are under the age of 70 or at most 75, and are otherwise healthy), radical treatment is generally indicated.
Radical treatment consists of either radiotherapy or radical prostatectomy. Radical prostatectomy involves surgical removal of the prostate and seminal vesicles. This can either be done through an abdominal or perineal (behind the scrotum) incision. If diagnosed early, for 80-90% of patients prolonged remissions or "cure" can be expected. The disadvantages of surgery include a temporary loss of continence (usually for several weeks or months following the procedure).
A small number of patients (2-20%) have impaired continence longer term, although very few patients with modern surgical techniques have severe incontinence as a long-term consequence. Male Impotence occurs in at least 50% of patients.
The alternative to surgery is radical radiotherapy, most commonly external beam radiotherapy. This normally involves a daily treatment for 6 weeks, and has short-term side effects which include urinary frequency, urgency, sometimes blood in the urine, and also bowel frequency, urgency and bleeding. Most of these side effects are short term, but a small percentage of patients can have ongoing radiation damage to the bowel and bladder. Erectile dysfunction affects 30-50% of men who have radical radiotherapy.
An alternative radiotherapy treatment is brachytherapy, where radioactive seeds are placed directly in the prostate, with the potential advantage of reducing the radiotherapy dose to the nearby bowel and bladder. Initial results with bachytherapy are encouraging, but this is a relatively new treatment, so there isn't good long-term data to assess results.
Hormonal treatment, regardless of the stage of the tumour is usually effective in causing remissison of prostate cancer, often for several years. When metastatic prostate cancer develops, the most effective treatment is hormonal treatment. This either involves orchidectomy (surgical removal of the testes), or medication designed to block the effects of testosterone (which stimulates the growth of prostate cancer).
PSA is used to test for the presence of prostate cancer. PSA is a tumour marker which has been helpful both as a screening tool in the detection of prostate cancer, for the staging of cancer, and also for measuring the response of treatment. In large scale screening 5-10% of a population will have an abnormal PSA. In addition to a PSA blood test, prostate examination should be done, as digital rectal examination can detect tumours missed by PSA alone (approximately 20%). Of late recently however, there has developed an enormous amount of concerning regarding the test findings and thus, PSA test controversy.
If the PSA is elevated or the prostate examination is abnormal, a transrectal ultrasound and prostate biopsy may be required. This proceedure is performed with a transrectal ultrasound probe, which is placed up the rectum (back passage), and several needle samples are obained from each side of the prostate. The proceedure is uncomfortable for most patients, but a general anaestetic is not usually required.