Men diagnosed with prostate cancer can choose from a wide range of treatment options. Depending on their age, expected life span, stage and grade of cancer, feelings about side effects and likelihood of a cure, men may be able to wait and see if the cancer spreads, undergo surgery, have radiation therapy or select hormone therapy. Other potential choices could include alternative treatments, such as cryosurgery or chemotherapy.
Watchful waiting, or expectant management, may be an option for men with slow growing cancer who are older or have other serious health problems. For them, treatment through surgery or radiation may not help them live longer. The side effects and associated risks of treatment also may outweigh the possible benefits. Watchful waiting involves carefully monitoring the cancer during checkups every three to six months and an annual transrectal ultrasound-guided prostate biopsy. Active treatment may be pursued if symptoms develop or the cancer begins to grow more quickly.
A man in good health may be a candidate for surgical treatment of prostate cancer. A radical prostatectomy involves removing the prostate, surrounding tissue and seminal vesicles. The procedure may be performed by making an incision either in the abdominal wall (retropubic) or the area between the scrotum and anus (perineal). These operations typically require a two-to-three-day hospital stay. Both procedures also may be performed using a laparoscope. Transurethral resection of the prostate (TURP) may be recommended to relieve symptoms by removing the inner part of the prostate that wraps around the urethra. TURP requires passing an instrument called a resectoscope through the penis into the urethra where electricity is used to vaporize tissue.
Radiation therapy uses high-energy X-rays or particles of radiation to either kill cancer cells or prevent them from growing. External beam radiation therapy focuses a beam from an outside source to target the cancer. There are several different types, including three-dimensional conformal radiation therapy, intensity modulated radiation therapy, and conformal proton beam radiation therapy. During internal radiation therapy, or brachytherapy, small radioactive pellets or “seeds” are placed directly into the prostate. The pellets are about the size of a grain of rice and cause little discomfort.
Localized prostate cancer also may be treated with cryosurgery, which requires freezing and destroying cancer cells. Cancer that has spread beyond the prostate may sometimes be treated with chemotherapy if hormone therapy has not been effective. Chemotherapy is not usually recommended to treat early prostate cancer.
Prostate cancer is a very complex disease, and each man’s experience will be unique. Regardless of the treatment path they ultimately follow, men should carefully evaluate all their options and even get a second opinion if they have several choices available. For more information about prostate cancer, talk with your doctor or visit the American Cancer Society Web site at www.Cancer.org.
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