Making the Choice That's Right for You
Once your prostate cancer has been diagnosed, graded, and staged, you have a lot to think about before you and your doctor choose a treatment plan. You may feel that you must make a decision quickly, but it is important to give yourself time to absorb the information you have just learned. Ask questions of your cancer care team. The treatment you choose for prostate cancer should take into account:
- Your age and expected life span
- Any other serious health conditions you may have
- The stage and grade of your cancer
- Your feelings (and your doctor's opinion) about the need to treat the cancer
- The likelihood that each type of treatment will cure your cancer (or provide some other measure of benefit)
- Your feelings about common side effects associated with each treatment
You should get a second opinion about the best treatment option for your situation. Prostate cancer is a complex disease, and doctors may differ in their opinions regarding the best treatment options. Speaking with doctors who specialize in different kinds of treatment may be helpful. You will want to weigh the benefits of each treatment against its possible outcomes, side effects and risks.
Seed Brachytherapy
Treatment of cancer using low dose radiation or "seed" brachytherapy was pioneered in the 1960s as an effective alternative to radical prostatectomy. The word brachytherapy derives from the Greek prefix brachy, meaning "short" or "close," because the seeds containing radioisotope are implanted directly into the cancerous prostate gland.
Seed Brachytherapy is a one-time, minimally invasive procedure usually performed in an outpatient setting by a radiation oncologist or urologist. To begin, patients are given a local or general anesthesia to block pain and help with relaxation. The procedure itself involves the placement of tiny seeds that contain a radioactive isotope inside the prostate via the guidance of ultrasonic equipment. On average the treatment takes just under one hour from start to finish.
The seeds immediately begin to emit radiation and, over a period of time, kill the malignant cells inside the prostate. The time it takes for the radiation to deliver its dose will depend on the isotope used. There are currently 3 isotopes commonly used in prostate brachytherapy: Cesium-131, Palladium-103 and Iodine-125. Cesium-131 (Proxcelan brachytherapy seeds) has the shortest half-life of the isotopes available, translating to faster delivery of the therapeutic dose. Brachytherapy seeds themselves are compatible with human tissue and remain in place permanently.
After the procedure, patients are taken to recovery and allowed to leave the clinic a few hours later. Most patients resume normal activities within 24-48 hours.
Actual image of brachytherapy seeds after implantation in the prostate
Surgery
There are several different types of surgical procedures for prostate cancer, with different benefits and risks associated with each. What is important to understand is that the risks associated with surgical removal of the prostate are much like those of any major surgery, including risks from anesthesia. In addition, most men undergoing prostate surgery will be hospitalized and have a long recovery time.
The common side effects of radical prostatectomy are urinary incontinence (being unable to control urine) and impotence (being unable to have erections). Both incontinence and impotence can affect a man, not only physically, but also emotionally and socially. These side effects are also possible with other forms of therapy, although with varying degrees of frequency and severity. The rate of complications increases with less experienced surgeons (Catalona, WJ, et al., "Potency, continence, and complication rates in 1870 consecutive radical retropubic prostatectomies". J. Urol., 1999.)
External Beam
With external beam radiation, the radiation comes from a large machine outside the body. Men go to the hospital or clinic for the treatment. There are 2 main types of external radio therapy: 3-D conformal and intensity modulated. On average, treatments are approximately 5 days a week for several weeks, requiring on-going trips to the clinic. Because the radiation comes from an external source, the skin in the treated area may become red, dry and tender. Permanent hair loss is also a possibility in the treated area.
As with other forms of prostate cancer treatment, urinary and sexual side effects are common and vary depending on the health of the patient, skill of the treating physician, dose of radiation received and the cancer itself.
High Dose Radiation
HDR temporary brachytherapy involves the placement of tiny plastic catheters into the prostate gland through a template that is sutured to the perineal skin below the scrotum. Once in place tiny radioactive seeds are inserted into each catheter. A computer controls the length of time the seeds deliver their radiation through the catheter. After the radiation has been delivered the catheters are removed, leaving no radioactive material in the gland.
Cryosurgery
Cryosurgery, accomplished by freezing and destroying the prostate, is another treatment option for prostate cancer. Using an ultrasound for guidance, a doctor inserts a probe filled with liquid nitrogen through the skin into the prostate, which freezes the prostate tissue. Cryosurgery usually requires a two or three day hospital stay. Damage to the nerves and blood vessels surrounding the prostate can cause complications, which may include incontinence and impotence.
Expectant Management (Watchful Waiting)
Depending on the characteristics of the cancer, some doctors may recommend an approach known as expectant management, or "watchful waiting." This approach involves closely monitoring the cancer without active treatment such as surgery or radiation therapy. This option may be recommended if your cancer is not causing any symptoms, is expected to grow very slowly, and is small and contained within one area of the prostate.
"Understanding Prostate Changes". National Institute of Health, 2004.
