Receiving a cancer diagnosis is one of the most terrifying experiences someone can have. And unfortunately, roughly one in 9 guys will be diagnosed with prostate cancer during their lifetime, according to the American Cancer Society.
Fortunately, a prostate cancer diagnosis is far from a death sentence. Roughly 96% of men treated for prostate cancer of all stages are alive 15 years after diagnosis and treatment.
Given how many men will have to navigate the often confusing or overwhelming world of treatments, we talked to several experts about the main ways to tackle prostate cancer, and how to know which course of treatment is right for you.
Watchful waiting or active surveillance
Many prostate cancer cases tend to be slow-growing, Dr. Howard Adler, medical director of the prostate care program at Stony Brook Medicine, explains to MensHealth.com. This means that the tumors grow so slowly that they’re unlikely to be life-threatening or impact quality of life. In fact, it might take 30 years for a prostate tumor to grow large enough to cause symptoms, according to the National Cancer Institute.
For these men, doctors recommend what’s known as watchful waiting or active surveillance. (The terms are often used interchangeably.) That’s because surgery and radiation therapy come with their own set of risks, such as post-treatment incontinence. It is recommended for early stage I and II prostate cancers.
Using this method, doctors
Sometimes, blood tests and biopsies may indicate that a guy’s cancer is likely to spread, making surgery or radiation necessary. Guys may undergo a prostatectomy to remove the entire prostate gland, since it’s not possible to simply remove the tumor due to the shape of the prostate, says Adler.
Generally, surgery is preferred for younger men, who have a better chance of not developing post-surgery side effects such as impotence and incontinence, Adler says. Additionally, once the prostate is removed, men are no longer able to produce semen. Testicles will continue to make sperm cells, but they are reabsorbed by the body.
Doctors may perform a traditional open surgery, which involves making an incision in the lower abdomen. Alternatively, a surgeon might perform a robot-assisted operation, which requires using special instruments to perform the operation through a handful of tiny, keyhole-sized incisions. This tends to leave patients with less pain and scarring.
“The majority of procedures are being done robotically these days,” says Adler. However, he believes it’s more important to choose a skilled surgeon and let them pick whichever style they’re most adept at.
Eric Klein, M.D., Chairman of the Cleveland Clinic Glickman Urological and Kidney Institute, says that “the bottom line with radical prostatectomy is that the surgeon’s experience matters more than the technique. At the Cleveland Clinic, the outcomes after prostatectomy—cure, preservation of continence and potency, pain, and recovery time—are almost identical between open and robotic surgery.”
External Radiation Therapy
Radiation therapy involves using high-energy X-rays or particles like protons to kill cancer cells and shrink tumors. Thanks to modern technology, doctors are able to vary intensity of the rays to better target the different areas of the prostate.
“With protons, we can also deliver radiation with more control inside a patient. This results in a higher dose to the prostate and a lower dose to more sensitive areas like the bladder and rectum,” says Andrew Lee, M.D., M.P.H., associate professor of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston.
Short-term, the risks of radiation are few. However, since radiation causes collateral damage to nearby healthy tissues, there are concerns down the road. “In 10 to 20 years, you may still be cured of prostate cancer, but the radiation may have caused bladder or rectal damage that can cause dysfunction in voiding, which can have a serious impact on your quality of life,” Klein says.
Internal Radiation Therapy
If you’d rather not make regular trips to the hospita to receive external radiation, you could do it at home with brachytherapy.
In a 90-minute outpatient procedure under general anesthesia, your surgeon uses a long, thin needle to implant 100 or so radioactive seeds, each about the size of a grain of rice, throughout your prostate. The seeds emit low doses of radiation that kill neighboring cancer cells. The radioactivity dissipates over several months, and in most cases the seeds are left in permanently. (You can’t see or feel them.)
“The greatest advantage of brachytherapy is convenience,” Lee says.
Overall, the risks are comparable to those of external radiation, though you may need to take a few extra precautions. “During sex, you could excrete the seeds into your partner, so we recommend wearing a condom,” Lee says.
Is surgery or radiation better for prostate cancer?
According to Adler, one isn’t a better choice than the other. It comes down to personal preference and what an individual is comfortable with.
“The best information out there suggests that outcomes seem to be similar for surgery and radiation,” he says.
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