Prostate Cancer Treatment: Do Your Homework, Know Your Options

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By Bruno Nahar, MD

According to the American Cancer Society, prostate cancer is the most common cancer among men, after skin cancer, and nearly 175,000 new cases will have been diagnosed by the end of 2020.  When men are diagnosed with prostate cancer, they have to make sense of a variety of treatment options presented to them and must make an educated choice .

More than 90 percent of men diagnosed with prostate cancer, have localized disease, defined as cancer that hasn’t spread outside of the prostate.  For some patients, urologists may recommend active surveillance, or monitoring low grade disease with periodic prostate specific antigen (PSA) tests.  But active surveillance may be difficult for patients who have been told they have cancer and do not want to live with the risk of it growing in their bodies.  

Two standard choices have dominated treatments – radical prostatectomy and/or radiotherapy.  However, a newer, minimally invasive treatment called high-intensity focused ultrasound (HIFU) has emerged in the U.S. and is  an appropriate, non-invasive choice for prostate cancer patients who meet certain criteria. 

Recently I spoke on a panel with three prostate cancer patients who each had different treatment options (linked here). The 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, complete with potential side effects.

Prostatectomy 

Prostatectomy is a surgical approach to treating prostate cancer involving the removal of the entire prostate and seminal vesicles. It requires one-to-two night stay in a hospital. 

Risks and side effects include: 

  • Urinary incontinence (inability to control the flow of urine from the bladder)
  • Erectile dysfunction
  • Penile shrinkage

Radiotherapy

Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation is common, and often used as the initial treatment for cancer that is still in the prostate gland. Cure rates for men with these types of cancers are about the same as those for men treated with prostatectomy. 

Risks and side effects: 

Side effects include: 

  • Bowel problems 
  • Radiation can irritate the rectum and cause a condition called radiation proctitis (leading to diarrhea, sometimes with blood in the stool and rectal leakage) 
  • Urinary problems
  • Radiation cystitis (urinating more often, burning sensation while urinating and/or blood in urine)
  • Urinary incontinence (no control of urine) 
  • Erection problems, including impotence
  • Lymphedema

High Intensity Focused Ultrasound (HIFU) 

High Intensity Focused Ultrasound, or HIFU for short, is a noninvasive option for patients with localized prostate cancer.  HIFU combines magnetic resonance imaging and biopsy data with ultrasound guided imaging to enable doctors to precisely target and destroy only the diseased tissue, and spare surrounding structures of the prostate.  

The most advanced HIFU system is Focal One, which is being used at hospitals across the country, including University of Miami Miller School of Medicine, The John Wayne Cancer Institute, UCI Health, Maimonides Health in Brooklyn, University of Rochester and Houston Methodist Hospital, among others.  

Risks and side effects: 

  • Short term catheter required following treatment
  • Potential inability to ejaculate
  • Low rate of urinary incontinence and erectile dysfunction

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. 

Dr. Nahar is a practicing urologist, and is an assistant professor in urologic oncology and robotic surgery at the University of Miami Miller School of Medicine.

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