The treatment of prostate cancer is complex and depends on a multitude of issues that includes the grade and stage of the cancer along with the age, overall health and the type of treatment that the patient is comfortable with. For older men who may have a slow growing tumor or a low life expectancy the treatment may just be watching and waiting, along with keeping the man comfortable. There are three types of treatment for prostate cancer that includes surgery, radiation therapy, and hormone manipulation.
Surgery for prostate cancer includes several types of prostactectomies. For men in the early stages of the disease the cure may be as easy as having a prostatectomy. There are four types of prostactectomies.
• A radical prostatectomy involves removal of the prostate, prostatic capsule, seminal vesicles, and a portion of the bladder neck. Many men experience varying degrees of urinary incontinence and erectile dysfunction.
• A retropubic prostatectomy is most often performed because it allows adequate control of bleeding, visualization of the prostate bed and bladder neck, and access to pelvic lymph nodes.
• A perineal prostatectomy is often the preferred choice for older men or men who might be poor surgical risks. This approach takes less time and there is less bleeding.
• A suprapubic prostatectomy is used if problems with the bladder are expected, but otherwise is seldom used. It is more difficult to control any bleeding because the surgical approach is through the bladder.
If the cancer is stage 3, or locally advanced beyond the prostatic capsule, treatment by surgery becomes somewhat controversial because of the likelihood of hidden lymph node metastasis and relapse. A prostatectomy, if performed, is used to help relieve urinary obstruction, but not to treat the cancer.
Radiation therapy may be used as a primary treatment for prostate cancer. Long term problems of impotence and urinary incontinence may be avoided and survival rates are comparable to that of surgical treatment.
Radiation may be delivered either by an external beam or interstitial implants of radioactive seeds of iodine, gold, palladium, or iridium. Interstitial radiation has a lower risk of impotence and rectal damage than external beam radiation.
Radiation has a palliative role for men with metastatic prostate cancer, reducing the size of bone metastasis, controlling pain, and restoring function, such as continuity.
Androgen depravation therapy is used to treat advanced prostate cancer. Many cells in the growing tumor are androgen dependent and either stop growing or die if stripped of androgens. Other cancer cells, unfortunately, thrive without androgen and are unaffected by therapy to reduce circulating androgens. The effects of hormone therapy can vary from complete but temporary regression of the tumor to no response at all.
The key to successful prostate cancer treatment is early detection and treatment. This is why it is so important for men in their 40s and older to go to their doctor for regular prostate exams. Cancer of the prostate can be successfully treated if its in its early stages of development.