What if I Have Got Prostate Cancer

 

Even if your PSA test picks up a cancer early, there's no proof that treating it will help you live any longer. Most men with early Prostate Cancer will not die as a result of it, particularly if you are in your 70's or 80's. It is also worth bearing in mind that the surgery and treatment options available can have complications such as impotence and incontinence.

What are the treatments for Early Prostate Cancer, and which is right for me?

Early cancers are dealt with in one of three ways: by watchful waiting, or by radical approaches: radical prostatectomy or radical radiotherapy (brachytheraphy). All these treatments can have very different effects on a man's quality of life and it is often left up to the patient to make an informed decision. Generally though, doctors recommend that the younger the patient, the more radical the treatment should be as the cancer is more likely to grow and cause harm.

Watchful Waiting

This involves regular check-ups in order to monitor the growth of the cancer. As there is no active treatment - unless symptoms develop there are no adverse side effects to worry about. You will visit the doctor every 6 - 12 months and they will be looking for a rise in the PSA level or a change in your condition.

Radical Prostatectomy

A radical prostatectomy is a major operation to remove the whole prostate and any cancer inside it. Unfortunately 3 - 4 out of 10 men having a radical prostatectomy that cancer will already have spread to surrounding tissue, making the operation ineffective. However, your PSA should fall to a very low level following the operation and as long as it does not rise, it is considered that you are free of cancer. Radical prostatectomy is generally recommended for men with a life expectancy of 10 years or more, who are fit enough to cope with a major operation.

Side Effects:

  • 3 out of 10 men will suffer mild urinary incontinence
  • 2-5 in 100 will suffer from permanent severe incontinence
  • Almost all men will have some difficulty achieving an erection (Viagra may be prescribed to help this)
  • All men will be infertile
  • 1 in 10 men will have bladder problems caused by scarring and will need another operation.

If you feel your life expectancy is less than 10 years, the severe adverse side effects of surgery on your quality of life may not be worth any possible gain in extra years. Even if your life expectancy is more than 10 years you may be more concerned about your quality of life. This is a decision that only you can make.

Radical Radiotherapy

It is possible to give radical radiotherapy in three ways. The first is by 'external beam' where radiation is targeted on the prostate and surrounding tissues to destroy cancer cells. The second 'conformal radiotherapy' is a modification of external beam but is a more targeted approach. It seeks to minimise the radiation to the surrounding area. Conformal radiotherapy may or may not be available in your area.

As with surgery radical radiotherapy is recommended for those men with a life expectancy of 10 years or more. It is a good option for men whose cancer is at the stage where it can be treated radically but who are not fit enough or do not want to undergo surgery.

Side Effects:

  • 7 out of 10 men will have bladder or rectal irritation, this can be painful but will usually settle within a few weeks
  • Up to 5 in 100 men will have long term bladder or rectal incontinence
  • 3-4 out of 10 men will have difficulty achieving an erection
  • Most men will be infertile
  • Some men will lose their sex drive.
  • You will have 20-40 daily sessions in the radiotherapy clinic over 5-8 weeks but will not have to stay in hospital. Radiotherapy does not cause any pain, however you may feel more tired than normal.

In the first few months after treatment you will probably have less energy than normal and may suffer from diarrhoea. You should receive from your clinic a list advising you which foods to avoid at this time to help.

Brachytherapy

Brachytherapy is radiotherapy delivered internally and in the last six years the techniques have become more streamlined and its results are now equivalent to surgery. Brachytherapy involves implanting dozens of tiny radioactive seeds directly into the prostate gland. This has the advantage of delivering a high dose of radiation whole minimising the damage to health tissues such as the bladder.

Brachytherapy relies on ultra sound or CT scanning to guide the placement of this needle through the skin into the prostate. With high dose bracytherapy you may have a local anaesthetic and will have to stay in hospital over night. The seeds are placed and removed in the prostate in four sessions over a period of 2 days.

Permanent seed bracytherapy uses radioactive seeds that are placed in the prostate once; you will not need to stay in hospital. The seeds lose radioactivity over time and will therefore not harm anyone you come into contact with.

This treatment is relatively new and so long term results are not yet known. However, more than 90% of patients remain free of disease for 5 years after the treatment.

Side Effects:

  • Temporary discomfort following implants
  • Temporary bladder problems
  • Sexual impotence can occur but is less frequent than after surgery.