The traditional approaches to treating prostate cancer
are surgery, radiation therapy, watchful waiting, and hormonal treatment. This
document presents an overview of the risks and benefits of each of these
approaches as well as a peek into newer treatment approaches.
Complete removal of the prostate is one of the most common treatments for
prostate cancer. Today, most of the procedures are done in ways that attempt to
spare the nerves controlling your bladder and erections. These nerve-sparing
surgeries reduce, but do not eliminate, the risk of incontinence and impotence.
The open radical prostatectomy procedure is performed
through a 5 to 8 inch incision (cut) between the umbilicus and the pubic bone.
The robotic-assisted laparoscopic radical prostatectomy involves inserting
surgical instruments and a video camera though 5 to 6 small (0.5-inch) incisions
in the abdomen; these are attached to a robotic that the surgeon controls using
a video console. A small (3-inch) incision is made to remove the prostate
specimen at the end of the robotic procedure.
Robotic prostatectomy is gaining popularity due to the
appeal of smaller incisions and less blood loss. However, there do not appear to
be substantial differences between the open and robotic procedures in the most
important outcomes: cancer control, complications, urinary continence, and
sexual function. The technical skill of the surgeon appears to be a major
determinant of a successful outcome.
Most men lose control of their ability to
urinate after surgery, and the problem could last for months. While most men
gradually improve, about 10 percent will leak urine after coughing or other
stressors. One percent or less will have a more severe long-term problem that
can be fixed by the placement of an artificial sphincter. Despite the reduced
risk of impotence with nerve-sparing surgery, many men will lose some degree of
sexual functioning. Estimates of the number of men with impotence are wide
ranging – from 20 to 70 percent – with this range being complicated by the
number of men with possible pre-existing sexual dysfunction and the reported
stage of cancer.
Prostate cancer surgery often provides peace
of mind because it removes the cancer. Men whose cancer has not spread beyond
the prostate have a 90 percent chance of surviving and being cancer-free 10
years after surgery.
Radiation is about as effective as surgery to prevent cancer from spreading over
a 10-year period. There are two types of radiation therapy – external beam
radiation and brachytherapy.