| Treatment |
Advantages |
Disadvantages |
Cure?
Yes or No |
Alternatives
if no cure
|
|
|
|
|
|
| Diligent
waiting |
|
|
|
|
No active
treatment right away.
You and your doctor watch for signs
that the cancer maybe changing, growing or spreading.
You schedule doctor visits and tests.
|
You
don't have to deal with side effects or complications of active
treatment.
You can always change your mind and begin active
treatment.
It is low in cost (cost and money) |
The
cancer could quietly spread and become harder to cure.
If not
carefully followed, the cancer may progress in the prostate
area and cause you symptoms such as difficulty passing urine,
bleeding, impotence, or pain.
It can be stressful to go on
with daily life not knowing what your cancer might do. |
No |
Begin
an active treatment |
| Radical
prostatectomy |
|
|
|
|
| With/without
pelvic lymph node dissection and nerve sparing |
One-time
procedure; prostate and occasionally some lymph nodes removed.
May cure if all prostate cancer is removed.
Allows accurate biopsy, cancer staging.
PSA goes to undetectable if no prostate cancer left in your
body.
|
2-4%
incidence permanent Incontinence.
20-40% incident permanent
impotence.
Rarely, blood transfusion needed, nerve injury, bladder neck constriction,
rectal injury.
|
Yes,
if no prostate cancer left in your body. |
If
prostate cancer remains in the prostate area, external beam radiation
is used.
If prostate cancer has spread to distant organs or
tissue, hormones are used. |
Cryosurgery/
Cryotheraphy |
|
|
|
|
| |
One-time
procedure; prostate remains in a shriveled state; can be used in those
who can not undergo radical prostatectomy.
Minimally invasive, no blood loss.
Used as salvage procedure for a local recurrence after external radiation. |
Impotence,
urethral strictures, urinary retention, frequent urination,
dysuria (painful or difficult urination), hematuria (blood
in the urine), penile or scrotal swelling |
|
|
| External
beam radiation therapy (XRT) |
|
|
|
|
| |
Avoids
major surgery; may cure early stage prostate cancer.
Incontinence
and impotence less common than surgery.
No transfusion risk.
|
Fatigue;
skin reaction in treated areas; frequent urination and dysuria
(painful or difficult urination); proctitis (inflammation of
rectum and anus), rectal bleeding, frequent stools, urgency;
bowel function may remain abnormal; hematuria (blood
in the urine).
Rare: fistula (abnormal tube like passage to other organs, cavities).
No lymph node or complete prostate biopsy for staging.
Yes, in
Requires
daily treatments for weeks. Typically treatments 5 days a week
for 6 to 7 weeks.
30-50% chance of erectile dysfunction (ED); 10-15% chance bladder
and/or rectal irritation.
May have hair loss in area receiving full dose such as pubic hair.
PSA doesn't go to undetectable levels.
|
Yes,
if prostate cancer is localized. |
Hormone
treatment, which is palliative.
Salvage prostatectomy with increased risk of incontinence.
|
| Internal seed radiation (brachytherapy)(IRT) |
|
|
|
|
| |
Minimally
invasive; quick recovery short hospitalization; no transfusions. |
Not
for every patient (men with high grade cancer; PSA above 10,
Gleason score 7 or above, are more likely to fail).
Large glands are more difficult.
Urinary frequency,urgency, hematuria (blood
in the urine), rectal irritation, pain,
urgent bowel movements.
Chances of impotence or pain with ejaculation; 25-60% chance of
impotence.
No
lymph node or complete prostate biospy for staging; urinary retention;
harder to do if have had prior TURP. |
Yes,
over the short term, if diagnosis is localized prostate cancer,
brachytherapy appears to be curative; long-term data need to be
reviewed. |
Salvage
prostatectomy if localized. hormones if distant disease. |
| Hormone therapy |
|
|
|
|
Therapy
in which the male hormones (androgens) are eliminated from
the body.
Primary treatment for older men with prostate cancer who don't
want surgery or forms external radiation therapy but also don't
want watch and wait.
Also used as a therapy for men with metastatic disease.
|
Orchiectomy:
One time procedure avoids the need for shots; it drops testosterone
quickly to almost zero and is permanent.
Injection therapy:
Not permanent.
Antiandrogen therapy:
Blocks
cell's ability to absorb the androgen hormone often used in
conjunction with with shots. Most antiandrogens are not effective
as a single agent.
Casodex (150 mg per day): Therapy is awaiting FDA approval
to be used as a single therapy that is as effective as the hormone
shots and would maintain libido and erections.
|
Orchiectomy:
Permanent outpatient procedure involves minor surgery, risk of infection,
bleeding, pain.
Injection therapy:
Can have flair of bone pain in those with bone metastases; need to pretreat
these men with androgen receptor blocker; requires visits/or
shots every 1-4 months, which can be expensive.
Antiandrogen therapy:
Diarrhea, liver damage, impaired night vision.
Casodex monotherapy:
Gynecomasia (enlarged breasts), limited data available.
Other disadvantages of hormone treatment:
Hot flashes, breast tenderness, decreased sex drive.
|
No:
hormone therapy stops the growth of those prostate cancer cells
hormone sensitive. Used for treatment of metastatic disease. |
Chemotherapy |
Source: 100 Questions & Answers About Prostate Cancer, provided by
TAP Pharmaceuticals Inc., 2003.
