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Treatment Choices for Men With Early-Stage Prostate Cancer

  • Posted: 02/11/2011

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Comparing Your Treatment Choices

The charts below list 9 common questions and answers for the 3 treatment choices discussed in this booklet. As mentioned before, most men will need more information than found in this booklet to reach their decisions. You may use the questions in these charts as a guide for talking with your doctor or learning more about your choices.

Questions:

  1. Which treatment is a good choice for me?
  2. What can I expect during treatment?
  3. What are the benefits of each treatment?
  4. What are the side effects and other drawbacks of each treatment?
  5. How will this treatment affect my sex life?
  6. What can be done to help with side effects?
  7. Will I have pain?
  8. Will I need other treatments?
  9. How long can I expect to live after I have this treatment?

 1. Which treatment is a good choice for me?

Active Surveillance
  • If your cancer is:
  • If you are in your 70s or older, or have serious medical problems.
  • If you are able to accept the fact that the cancer will remain in your body.
  • If you can be careful about always going to your check-ups.
Surgery
  • If you are younger than 70 and in good health.
  • If you want the cancer to be removed.
  • If you are able to accept that you might have serious side effects.
  • If you are able to accept that you may still need radiation therapy after your surgery.
Radiation Therapy
  • If you are a man of any age with early-stage prostate cancer.
  • If you have serious health problems that do not allow you to have surgery.
  • If you are able to go for treatment 5 days a week for up to 9 weeks.
  • If you have high-risk cancer (see Your prostate cancer risk group) that is less likely to be cured by surgery alone.



 

 2. What can I expect during treatment?

Active Surveillance
  • You will not start treatment right away.
  • You will have frequent visits to the doctor.
  • You and your doctor will watch for signs that the cancer may be changing or growing. You will have:
    • Frequent DRE and PSA tests, usually every 3 months
    • Biopsies every 1 to 3 years
Surgery
  • Surgery takes about 2 to 4 hours.
  • Most patients stay in the hospital for 2 to 4 days.
  • The doctor will remove the entire prostate, the seminal vesicles, and a small part of the bladder.
Radiation Therapy
  • External Beam Radiation
    • Your doctor will figure out the dose of the radiation to the cancer with the least damage to the normal tissue nearby.
    • You will lie on a table while a large machine aims radiation at your cancer.
    • You will have no pain or discomfort.
    • You will have treatment once a day, 5 days a week, for up to 9 weeks.
  • Brachytherapy
    • LDR brachytherapy
      • Your doctor will insert radioactive seeds (each smaller than a grain of rice) into the prostate or surrounding area. He or she will implant the seeds using hollow needles inserted through the space between the scrotum and the anus.
      • You will be numbed below the waist or put to sleep.
      • It takes an hour or so for the doctor to implant the seeds.
      • You will spend a total of 5 to 6 hours in the hospital and should not need to spend the night.
      • The seeds will stay in your body even after the radiation is gone.
      • While the seeds are giving off radiation you should avoid being near children or pregnant women.
    • HDR brachytherapy
      • A doctor will insert tiny catheters into the prostate or surrounding area.
      • The doctor will deliver a radioactive source to the prostate through the catheter and remove it after a short time.
      • Most people have 3 treatments over 24 hours.
      • You will remain in the hospital until you have finished all of your treatments.
      • Once you have finished your treatments, the catheters will be removed.

 3. What are the benefits of each treatment?

Active Surveillance
  • You will have no side effects.
  • Your doctor will follow you closely and you will have regular check-ups.
  • You can decide to begin treatment at any time.
Surgery
  • The prostate cancer is removed by removing as much of the prostate as possible.
Radiation Therapy
  • External Beam Radiation
    • You will not need to spend the night in the hospital.
    • You will not need to be numbed below the waist or put to sleep.
    • You may have fewer problems with urination than if you have surgery.
  • Brachytherapy
    • For LDR brachytherapy, you will not need to spend the night in the hospital.
    • It can be easier on your body than surgery.
    • There will likely be less damage to the rectum and nearby tissue than with external beam radiation.

 4. What are the side effects and other drawbacks of each treatment option?

Active Surveillance
  • You may have feelings of worry and anxiety about living with cancer and putting off treatment.
  • The cancer needs to be followed closely.
  • You will have frequent tests, such as blood tests and biopsies.
  • The cancer could spread and become harder to treat.
Surgery
  • There are risks with any major surgery, such as pain, bleeding, infection, heart problems, or death.
  • It takes longer to recover than it does with radiation therapy.
  • For 1 to 2 weeks after surgery, you will need to use a catheter (a hollow tube) to pass your urine.
  • You may have problems with incontinence, which means you are not able to control the flow of urine. Managing this problem often means wearing pads, such as Depend® pads, to catch urine. The most common type of incontinence is passing a small amount of urine from the stress of coughing, laughing, or sneezing. A small number of men may have more serious incontinence that can last the rest of their life.
  • Most men will have trouble getting an erection right after surgery, a problem called impotence, erectile dysfunction, or ED. This may improve over 1 to 2 years. Erectile dysfunction may occur if the cancer is close to the nerves that control erections. If these nerves are damaged or removed during surgery, there is a strong chance that you will have problems with erectile dysfunction after surgery. Other factors that affect erectile dysfunction are your age, medicines you take, your hormone levels, other health problems, and how strong your erections were before surgery.
Radiation Therapy
  • External Beam Radiation
    • During Treatment
      • Fatigue (being very tired) toward the end of your course of treatment
      • More frequent and softer bowel movements
      • Urinary problems, such as needing to go more urgently and more often, especially at night
      • Irritation or bleeding from your rectum
    • After Treatment
      • You may develop erectile dysfunction within 5 years of treatment. Half of the men who have radiation therapy will develop problems with erectile dysfunction that are like those seen with surgery.
      • You may develop bowel problems, such as diarrhea, trouble controlling bowel movements, and rectal bleeding.
      • You may feel discomfort in the bladder or rectal area.
      • Your PSA may go up for a short time.
  • Brachytherapy
    • During Treatment
      • More frequent and urgent need to pass urine
      • More discomfort when passing urine
      • Bowel problems, such as diarrhea, trouble controlling bowel movements, and rectal bleeding
    • After Treatment
      • You may develop problems with:
        • Emptying your bladder
        • Dribbling of urine
        • Erectile dysfunction, similar to that found with surgery

 5. How will this treatment affect my sex life?

Active Surveillance
  • It should not affect your sex life.
Surgery
  • Surgery to remove the prostate can cause erectile dysfunction. Talk with your doctor about whether nerve-sparing surgery can be used to limit damage to the nerves that control erections. Medications and devices can help many men with erectile dysfunction (see What can be done to help with side effects).
  • After your prostate is removed, your orgasm may be “dry,” which means that you will make little, if any, semen. If you want to have children in the future, you will need to bank your sperm before surgery. Banking your sperm means freezing it for future use. See Ways to Learn More for more information.
Radiation Therapy
  • You are just as likely to develop problems with erectile dysfunction as you are with surgery. But, these problems will develop 3 to 5 years after treatment, rather than right after. Your age and health can also affect problems you might have with erectile dysfunction.

 6. What can be done to help with side effects?

Active Surveillance
  • You will have no side effects
Surgery
  • For erectile dysfunction
    • There are medicines you can take by mouth that can increase blood flow to the penis, leading to an erection. They work best for men who have had nerve-sparing surgery. These medicines include:
      • Sildenafil (Viagra®)
      • Vardenafil (Levitra®)
      • Tadalafil (Cialis®)
    • There are also medicines you can give yourself with a shot into the penis. Once you give yourself the shot, it will take about 5 minutes to start working and the effect will last for 20 to 90 minutes.
    • If medicine you take by mouth or shots do not help you, you should talk with your doctor about other choices. Other choices that may lead to an erection include:
      • Medicated urethral system for erection, also called MUSE, in which you insert a small pellet into your urethra using an applicator.
      • Vacuum erection devices, which use a vacuum tube connected to a pump to help produce an erection. The pump helps blood flow to the penis.
      • Penile implants, which are devices that are placed inside the penis through surgery. Implants can be firm rods or devices that inflate.
    • You may need to try different treatments or combination of treatments in order to find something that works for you.
  • For incontinence
    • Lack of bladder control may be severe for about 6 to 12 weeks after surgery. During this time, you will need to wear an absorbent pad, such as a Depend® pad.
    • Emptying your bladder often may help to control leaks. Other choices for managing incontinence include collection devices, biofeedback, and surgery.
    • Collection devices consist of a pouch or condom-like device that is securely placed around the penis. A drainage tube is attached at the tip of the device to remove urine. The drainage tube empties into a storage bag, which can be emptied directly into a toilet.
Radiation Therapy
  • Urinary problems
    • Talk with your doctor or nurse if you have urinary problems. He or she may refer you to a physical therapist who will assess your problem. The therapist can give you exercises to improve bladder control.
    • Your doctor may prescribe medicines that can help you urinate, reduce burning or pain, and ease bladder spasms.
  • For diarrhea
    • Drink plenty of clear liquids. After you have a bowel movement, clean yourself with moist wipes, instead of toilet paper.
    • Try eating smaller meals and snacks, instead of 3 large meals. Also, eat foods that are easy on the stomach. Avoid fried, greasy, and spicy foods, and those that are high in fiber, such as raw fruits and vegetables.

For more information about dealing with problems caused by radiation therapy, seeRadiation Therapy and You: Support for People with Cancer, a booklet from the National Cancer Institute. You can order a free copy at www.cancer.gov/publications or 1-800-4-CANCER (1-800-422-6237).

 7. Will I have pain?

Active Surveillance
  • You will have frequent tests, such as blood tests and biopsies, which may cause some discomfort.
Surgery
  • Some men have little pain after surgery, but others need pain relief. There are medicines that can help control pain after surgery. Be sure to tell your doctor or nurse if you need help.
Radiation Therapy
  • External beam radiation therapy
    • External beam radiation therapy itself does not cause pain, but over time it can cause side effects that cause discomfort in the bladder or rectal area. If you do have pain, be sure to tell your doctor or nurse.
  • Brachytherapy
    • You might feel mild pain where the seeds were implanted.
    • You might feel burning or pain when you pass urine.
Medicines can help with pain or discomfort. Be sure to talk with your doctor or nurse about your pain.

For more information about pain and how to manage it, see Pain Control: Support for People with Cancer, a booklet from the National Cancer Institute. You can order a free copy at www.cancer.gov/publications or 1-800-4-CANCER (1-800-422-6237).

 8. Will I need other treatments?

Active Surveillance
  • If tests show that your cancer is growing or changing, you may need surgery or radiation therapy. If you do not want to go through surgery or radiation therapy, are older or have other health problems, hormone therapy may be a good choice for you.
Surgery
  • Your doctor might suggest you have radiation therapy after you have had surgery.
  • Within 5 years of surgery, the blood level of PSA will start to go up again in about 1 out of 3 men. If your PSA level begins to rise, it may be a sign that your cancer has come back. If that happens, your treatment choices may include:
    • Active surveillance
    • Hormone therapy
    • Radiation therapy, especially if your PSA level is less than 1 ng/ml
Radiation Therapy
  • If you have high-risk cancer, hormone therapy may be used to shrink the prostate before radiation therapy. You might also take it for many years after radiation therapy.
  • Within 5 years of radiation therapy, the blood level of PSA will start to go up again in about 1 out of 3 men. If your PSA level begins to rise, your treatment choices will most likely include active surveillance or hormone therapy. Less often, your doctor may suggest surgery or cryotherapy.

For more information about treatment choices or clinical trials for prostate cancer, visit NCI’s Web site at www.cancer.gov/cancertopics/types/prostate or call the National Cancer Institute’s Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).

 9. How long can I expect to live after I have this treatment?

Active Surveillance, Surgery, and Radiation Therapy
  • Most men with early-stage prostate cancer can expect to have many healthy years ahead of them. The average age
    for men to learn they have early-stage prostate cancer is 65 years. For all 3 treatments:
    • Nearly all men will still be alive 5 years after treatment.
    • 86% of men will still be alive 10 years after treatment.
    • 56% of men will still be alive 15 years after treatment.
  • Even if the cancer comes back, there are many treatments that can help.