The Pros/Cons of Prostate Cancer Treatment Options
Treatment options for prostate cancer typically include proactive surveillance (also known as expectant management), radiation therapy, and radical prostatectomy. Each option has its share of pros and cons.
As a surgeon, my goals for each patient are the following:
1. Remove all cancer from the patient so he is cured.
2. Maintain optimal urinary function.
3. Do not adversely affect sexual function.
In my practice, I’ve found that men tend to make their treatment decisions based on a variety of factors, including the potential for side effects, perceived long-term risks, psychological ramifications and the financial cost of each therapy.
When I advise my patients on treatment options, I tell them it comes down to two factors:
1. The clinical stage of the cancer
2. The age and general health of the individual
The latest research has shown that, in healthy men who have more than a 10-year life expectancy, about 80 percent of prostate cancers detected by PSA testing have the potential to progress and thus warrant treatment. (The PSA test, which measures prostate-specific antigen—a protein produced in the prostate and released into the blood—is widely used as a tool to screen for the presence of prostate cancer.)
For the other 20 percent of prostate cancers detected, it is often more likely that that patient will die of something else long before the cancer in their prostate becomes problematic.
Proactive surveillance (or Expectation Management):
This option replaces other targeted treatments and surgeries with a period of observation and regular examinations. If, after careful monitoring, the symptoms progress, it is best to consider alternative treatments.
Pros: · Patients who choose proactive surveillance avoid the many side effects that accompany other preventative treatments.
A patient can also avoid many of the expenses associated with surgical or radiation treatments. · If it is determined that the cancer is growing slowly, further treatment may be unnecessary.
Cons: · Patients may experience high levels of anxiety when they feel they are doing “nothing” about a cancer living in their body.
Testing is not guaranteed to give an accurate assessment of the cancer. What appears to be small, slow-growing cancer may actually be both a large and aggressive form of cancer.
There are three types of radiation therapy: (1) External Beam Radiation: This procedure generally uses proton beam therapy to target radiation at the infected area, while avoiding any surrounding healthy cells.
Pros: The treatment does not involve anesthesia or surgical recovery time, and there's no pain during the procedure. The treatment only takes a few minutes each day and immediate side effects are mild and usually do not restrict daily activities.
Cons: · The length of the treatment--five days a week for up to two months--can be both inconvenient and time consuming, especially for men who must travel far to radiation treatment facilities.
More complications can occur because radiation treatment does not allow for examination of the lymph nodes. Often a physician will recommend a laparoscopic lymph node dissection before treatment if there is a suspicion of lymph node involvement.
Although radiation is precisely aimed to target the cancerous areas, healthy cells can also be damaged due to constant exposure. When these cells are damaged they can’t recover and the destruction results in unpleasant side effects.
- Rectal irritation affects 30 to 50 percent of men.
- Diarrhea affects between 30 to 50 percent of patients who are two to three weeks into the treatment. This side effect can be controlled with medication.
- Bladder irritation, including frequent urination and burning, affects 30 percent of patients.
- Fatigue is common during the conclusion of treatment and lasts for several weeks after treatment is completed.
- Temporary skin changes such as redness, dryness, scaling and itchiness occur two weeks after treatment begins and may last up to two weeks after treatment ends.
- Radiation proctitis is a radiation injury to the rectal wall that can be found in 1.5 to 3 percent of men. This side effect can be treated with the use of hydrocortisone enema or suppositories.
- Cystitis or bladder inflammation affects 1.5 to 2 percent of men.
- Incontinence is rare if there are no symptoms before therapy.
- Erectile Dysfunction is a gradual side effect that occurs two to five years after treatment ends. Erectile Dysfunction occurs in 30 to 40 percent of men under the age of 65 and 50 percent of men over the age of 65. After 3D conformal radiation, erectile dysfunction occurs in 15 percent of men.
Dr. Todd Breaux is a urologist at Akron General Medical Center.
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