Prostate Cancer Treatment Options
- Doug Bliss thought it was strange when he had an urgent need to go to the toilet while walking his dog. Thankfully, he did the right thing and called his doctor. This eventually led to his prostate cancer diagnosis.
- After permanent low-dose brachytherapy, Bliss is doing well today. His latest PSA test came back with a very low score of 0.4.
- Prostate cancer is the most common cancer in American men. Symptoms of prostate cancer are inconsistent and hard to pinpoint but may include changes in urinary function like urinating more or less often or waking up at night to go more than usual.
- Treatment for prostate cancer can vary greatly from person to person. Early-stage prostate cancers can be treated with many options including: active surveillance, watchful waiting, surgery, radiation and focal therapies, among other things.
- Brachytherapy is an internal form of radiation where small radioactive seeds are placed inside the prostate. The two forms of this therapy are permanent low-dose brachytherapy and temporary high-dose brachytherapy. The temporary option means you can have it done as an outpatient procedure that only takes one to two hours. If you choose the permanent therapy, doctors will place radioactive seeds directly into the prostate and leave them there to slowly release radiation over several weeks or months.
It was just before Christmas in 2015 when a 74-year-old Bliss experienced an unusual sensation.
Read MoreAfter doctors performed a PSA test, they noticed Bliss had a relatively high score of 13. He then returned to the hospital for an MRI the following day and a transrectal biopsy two weeks later. Sadly, there were some issues with his results.
“My biopsy didn’t match up with what the MRI scan showed,” he explained. “So they left it six weeks because they didn't want to do another biopsy too soon in case of any damage, and then did a second biopsy where they took many more samples, which then matched up with my scan.”
That’s when Bliss finally had answers in the form of a prostate cancer diagnosis. Fortunately, he had a fairly small tumor that had not spread outside of his prostate. He went on active surveillance for a few weeks until doctors decided to outline his treatment options.
"My options were explained well to me by the oncology unit, who gave me leaflets for each of the options for me to go home and read about, and discuss with my family,” he said. "I opted for brachytherapy because I felt it was the least intrusive out of all the treatments, and I was adamant that I didn't want my prostate removed. It was also important to me to have the ability to go back to normal life quickly."
Bliss underwent permanent low-dose brachytherapy about three months later and also began taking the drug tamsulosin.
"I went in at 8am, and I was out by 3pm,” he said of his brachytherapy. “I was out cold for the treatment, but I didn't have any pain when I woke up, and I was back at work the following day where I was delivering tires for a small local company at the time."
His biggest side effect was having trouble going to the toilet, and he was fitted for a catheter for around 15 months. He’s now doing well and continues to have yearly PSA tests. His latest one came back with a very low score of 0.4.
"A lot of my friends are quite surprised with how well my prostate cancer treatment and the journey has gone, or how little I've moaned about it,” he said. “I've always had a positive attitude, and when I was first diagnosed with it, I questioned myself do I worry or not? But what's the point in worrying if it's not hurting me and I'm not in pain? It's there, but it's treatable. I wouldn't put anyone against getting brachytherapy as it worked for me."
Understanding Prostate Cancer
Prostate cancer is the most common cancer in American men except for skin cancers. About one in eight men will be diagnosed with this disease during his lifetime. The disease begins in the walnut-shaped prostate gland located between the rectum and bladder. This gland produces the fluid that nourishes sperm.
When Should I Get Tested for Prostate Cancer?
Symptoms of the disease are generally inconsistent and hard to pinpoint.
"Prostate cancer is a very odd disease in that it doesn't have a particular symptom," Dr. Edwin Posadas, director of translational oncology and the medical director of the Urologic Oncology Program at Cedars-Sinai, explained.
But changes in urinary function like urinating more or less often or waking up at night to go more than usual could be a sign of the disease. However, it's important to note that these potential symptoms could also could be caused by a urinary tract infection or even an enlargement of the prostate gland (which is not cancer). Still, you should always consult a medical professional if any changes to your health arise.
There's No One Definitive Symptom for Prostate Cancer, But There Are Clues
Doctors who have spoken with SurvivorNet shared a hopeful outlook when considering a prostate cancer diagnosis because there are many treatment options and there's been significant treatment progress over the past decade.
Surgical and radiation options, for example, have made improvements in reducing side effects of treatment while still providing excellent cure rates. Even for men with an advanced-stage diagnosis, many new options exist to treat prostate cancer and help them maintain an excellent quality of life.
Treating Early-Stage Prostate Cancer
Treatment for early-stage prostate cancer can vary greatly from person to person. Doctors' treatment recommendations will depend on multiple factors, including the stage of the cancer, but they will also look at things like how aggressive your particular cancer is in nature. Additionally, prostate cancer is a disease where many doctors have differing opinions on what is the best treatment path to take. So, it can be a good idea to get multiple opinions.
One option for people with early-stage, low-risk prostate cancer is to undergo active surveillance.
"The concept of active surveillance is you're watching a man, and if something changes while the cancer is still in the prostate, you treat it then," Dr. James Brooks, the chief of urologic oncology at Stanford Medicine and director of the U54 Stanford O'Brien Urology Research Center, told SurvivorNet. "An ideal man for active surveillance might be a man, for instance, in his late 60s who has a barely elevated PSA, let's say just above 4, who undergoes a biopsy and is found to have one of the 12 biopsy cores with a small percent of low grade, what we call, Gleason grade 3 plus 3 prostate cancer.
"That man has a very low probability, it's certainly less than 1% chance, of dying of prostate cancer in 10 years."
The Benefits of Active Surveillance
Perhaps the biggest consideration for active surveillance is the fact that it allows you to preserve your normal functioning.
"You don't have to suffer some of those potential side effects of sexual dysfunction or urinary dysfunction," Dr. Brooks explained.
But even if you opt for active surveillance, there is still the chance you'll require treatment later down the line. About 50% of men who opt for active surveillance will have changes within five years that require active treatment, says Dr. Brooks.
In addition to active surveillance, watchful waiting may also be an option for older adults and those with other serious or life-threatening illnesses who are expected to live less than 5 years. Routine PSA tests, digital rectal examinations and biopsies are not usually performed if you've decided on watchful waiting, but treatment may be recommended if the prostate cancer causes symptoms, such as pain or blockage of the urinary tract,
For early-stage patients who do undergo active treatment, local treatments like surgery and radiation may get rid of the prostate cancer completely.
Laparoscopic Surgery vs. Traditional Open Surgery: What's the Best Choice for Prostate Cancer?
When surgery is performed, you can either have traditional open surgery or laparoscopy. The latter is more commonly used nowadays since traditional surgery requires a surgeon to make a large incision and laparoscopic surgery offers a smaller incision and a shorter recovery time. And a newer approach, known as a robotic-assisted laparoscopic prostatectomy (RALP), or robotic surgery, allows surgeons to make these small incisions with more precision.
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Radiation for prostate cancer, on the other hand, can either be done via external beam radiation and brachytherapy (internal radiation).
Brachytherapy is an internal form of radiation where small radioactive seeds are placed inside the prostate. The two forms of this therapy are permanent low-dose brachytherapy and temporary high-dose brachytherapy. The temporary option means you can have it done as an outpatient procedure that only takes one to two hours. If you choose the permanent therapy, doctors will place radioactive seeds directly into the prostate and leave them there to slowly release radiation over several weeks or months.
RELATED: The Benefits Of High-Dose Brachytherapy: Temporary and Fast
External beam radiation, on the other hand, delivers high doses of radiation to the tumor in the prostate in a non-invasive way. Experts say developing technology has allowed for more precision in the aim and amount of radiation administered.
"Over the last ten to fifteen years, we have done remarkable things with our technology that allows us to aim much more carefully, reduce the amount of radiation that nearby critical structures get, and thereby get a higher dose in a quicker period of time," Dr. Patrick Swift, a radiation oncologist and a Clinical Professor of Radiation Oncology at Stanford, previously told SurvivorNet.
Second (& Third) Opinions Matter When Deciding Between Surgery or Radiation
Focal therapies are another option for small prostate tumors. These less-invasive treatments can include cryosurgery (also called cryotherapy or cryoablation) and high-intensity focused ultrasound (HIFU).
Cryosurgery involves freezing cancer cells with a metal probe inserted through a small incision in the area between the rectum and the scrotum, the skin sac that holds the testicles. But it's crucial to note that this is NOT an established therapy or standard of care to treat newly diagnosed prostate cancer.
High-intensity focused ultrasound uses high-frequency ultrasound energy to heat and kill cancer cells in the prostate. This relatively new treatment is usually only offered to men with early stage, localized cancer that is in one area of the prostate, though it is admittedly rare to see a prostate cancer confined just to one area of the prostate.
But if patients do have such a diagnosis, HIFU can "reset the time clock on the cancer so they can avoid the full treatments until a later date," according to Dr. Swift. Still, you should be aware that the long-term effectiveness of HIFU is still being determined.
Depending on the stage and aggressiveness of your cancer, other treatments like hormone therapies and anti-androgen drugs may be recommended (which will be discussed more below). No matter what, you should feel confident in your treatment plan. Don't be afraid to get multiple opinions and really consider all your options.
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