In the early 1990s, roughly 30 percent of prostate cancer patients in the United States were treated by surgery, 30 percent by radiation, and 20 percent by watchful waiting. (Most of the rest were treated with a combination of therapies). In Europe, by contrast, watchful waiting constitutes the standard treatment for asymptomatic prostate cancer.
The popularity of surgery in this country has grown tremendously in recent years. A study of Medicare patients' records found that the number of men nationwide receiving radical prostatectomy by 1990 was six times greater than the number recorded for 1984, and the increase was seen in all age groups, from the youngest (that is, age 65) to men in their eighties. Recent statistics, however, indicate that since 1993, the rate of prostatectomies has been dropping.
If you have prostate cancer, you need to consider your age and general health before making a decision about treatment. You also need to think about which side effects you can live with. Some men, for example, cannot imagine living with side effects such as incontinence or impotence. Other men are less concerned about these and more concerned about survival.
Treatment decisions are often hard to make by yourself. No written information can take the place of talking directly with your health care professionals. In addition, talk with your family and friends and consider getting more than one opinion. It is natural for surgical specialists such as urologists to recommend surgery and for radiation oncologists to recommend radiation. Primary care doctors can help you choose the treatment that is best for you.You might find that speaking with others who have faced or are currently facing the same issues is useful.
Common Treatments
- Radical prostatectomy surgery (either open or robotically assisted ) removes the prostate, local lymph nodes and some surrounding tissue.
- Radiation therapy is delivered by external beam or implanted radioactive seeds (brachytherapy) to destroy the DNA of cancer cells, interfering with their ability to reproduce.
- Hormone therapy alters hormone levels to shrink the size of the tumor. Cryotherapy freezes the cancerous cells in the prostate.
- Watchful waiting ” makes use of careful observation without immediate treatment.
Possible Side Effects from Treatment
- Erectile Dysfunction: The likelihood of developing erectile dysfunction depends upon several factors including the patient’s age, other medical conditions and the method of treatment.
- Incontinence: The involuntary loss of urinary control can occur. Incontinence may be occasional, mild, frequent or severe.
- Treatment of side effects: Medical and surgical options exist for treating erectile dysfunction and incontinence. The first concern is to eradicate the cancer.