Prostate tumours grow slowly, often over a period of 10 years or more and are non-aggressive compared to most other types of cancer. They also tend to appear late in life. Especially in older men, small tumours are often left in place without any treatment. However, the doctor will check regularly to be sure the cancer isn't growing faster than expected. This is known as "active surveillance."
Cancer that has spread far beyond the prostate requires a range of antitumour and pain-killing treatments.
Cancer that hasn't spread beyond the prostate is usually treated with surgery or radiation.
One option for treatment is radiation therapy. Your doctor may use an external beam or radioactive seed implants inserted into or near the prostate through surgery (called brachytherapy) to destroy cancer cells. Researchers are looking for new ways to deliver radiation therapy, as well as the potential use of hormone therapy at the same time as radiation therapy (see the information below about hormone therapy).
If surgery is recommended, the standard operation is radical prostatectomy, the complete removal of the prostate gland. An incision is made either in the lower abdomen or between the anus and scrotum, and the prostate gland is removed. This is the method most likely to cure prostate cancer.
Removal of the prostate can have major side effects, including impotence and incontinence. A man's ability to have an erection after surgery depends on whether the nerves next to the prostate have been damaged. Sometimes, the nerves are affected by cancer and must be removed. Other times, the doctor tries to leave them in place but impotence occurs anyway. Your doctor should be consulted about the likelihood of a "nerve-sparing" procedure in any specific case.
When deciding on whether surgery or radiation is the best choice to treat prostate cancer, both the doctor and patient need to discuss the risks and benefits. Both forms of treatment have complications, such as bladder irritation, sexual dysfunction, and bowel symptoms, and the decision will depend upon the disease extent, general health, and preferences of the individual patient.
Sometimes the cancerous tissue is killed with a cold probe (cryosurgery) that freezes it. This technique can also cause impotence. It's fairly new, so we don't know if long-term results are as good as those of radical prostatectomy.
Hormonal therapy involves reducing the levels of the hormones like testosterone (called androgens) or blocking the cancer cells from detecting those hormones. Prostate cancer cells rely on androgens to grow. This treatment can also cause the prostate to shrink. It won't cure the cancer, but it can control the growth of the tumour and may be useful before surgery, especially cryosurgery. Instead of using medications, some men may choose to reduce their levels of testosterone by having their testicles removed (orchiectomy).
Both hormones and radiation are common treatments in patients whose cancer has spread or come back after surgery. Chemotherapy can be used for prostate cancer when hormonal therapy is no longer working.
Your doctor will discuss treatment options based on the size, type, and location of the cancer.
If you are worried about developing prostate cancer, you should ask your doctor about PSA testing and digital rectal exams.
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