Side Effects: Weighing The Risks Vs. Benefits
- For patients undergoing prostate cancer treatment, incontinence (loss of bladder or bowel control) and erectile dysfunction are typically the biggest concerns when it comes to side effects.
- These days, there are many techniques and treatments that can be used to try to avoid these side effects — and to help mitigate them when they do happen.
- Choosing a treatment for prostate cancer involves balancing the potential benefits and side effects of each approach.
- Surgery, radiation, and hormone therapy all have unique side effect profiles — and though each can play a critical role in managing the disease, it’s important to have a thorough conversation about risks vs. benefits with your doctor.
“The prevailing thought is, if I have surgery, I’m going to be impotent, I’m going to be incontinent — and that’s not necessarily true,” Dr. Shirin Razdan, director of the robotic surgery department at the Comprehensive Urological Surgery Institute in Miami, tells SurvivorNet. These days, there are many techniques and treatments that can be used to try to avoid these side effects — and to help mitigate them when they do happen.
Read MoreRadical Prostatectomy (Surgery)
A radical prostatectomy is a surgical procedure in which the entire prostate gland (and sometimes nearby tissues, including lymph nodes) is removed. This can be done through open surgery or with robotic-assisted laparoscopic techniques.
Common side effects of surgery include:
- Urinary incontinence
- Erectile dysfunction
As with any surgery, there are also risks such as bleeding, infection, and complications from anesthesia, although these are relatively rare in experienced hands.
These side effects often improve over time — and there are surgical techniques your team can make use of to reduce the likelihood that you will deal with them.
“Proper nerve preservation, adequate urethral length, and urethral preservation can really significantly improve a man’s functional outcomes after surgery,” Dr. Razdan explains.
Radiation Therapy
Radiation therapy uses high-energy beams to kill cancer cells. It can be delivered externally (external beam radiation therapy or EBRT) or internally (brachytherapy, where radioactive seeds are implanted in the prostate).
Side effects of radiation include:
- Urinary symptoms (increased frequency or urgency, burning sensations)
- Bowel issues (changes in stool or bleeding)
- Erectile dysfunction
- Fatigue
One major difference is that radiation therapy does not involve the physical removal of the prostate, so urinary incontinence is generally less common and less severe than after surgery.
Radiation side effects can also develop more slowly, over time, whereas surgery side effects would be felt in the immediate aftermath.
Hormone Therapy
Hormone therapy (androgen deprivation therapy or ADT) is used to lower or block the body’s production of testosterone, which fuels the growth of most prostate cancers. This treatment is commonly combined with radiation in intermediate- and high-risk patients to improve outcomes.
Common side effects of hormone therapy include:
- Hot flashes
- Decreased libido and erectile dysfunction
- Fatigue and weakness
- Loss of muscle mass and increased body fat
- Bone thinning (osteoporosis)
- Mood changes and depression (hormonal shifts can also affect emotional health)
- Metabolic changes
Despite these side effects, hormone therapy plays a critical role in reducing recurrence and improving survival when used appropriately. Many side effects are reversible once treatment is stopped, though some changes may persist.
What Are HIFU & Cryosurgery?
While surgery and radiation remain the primary treatments for prostate cancer, other local therapies are available, especially in certain circumstances. Two such options are High-intensity focused ultrasound (HIFU) and cryosurgery.
HIFU uses focused sound waves to heat and destroy prostate tissue. A probe inserted into the rectum delivers ultrasound waves directly to the prostate, creating localized heating that ablates cancer cells.
HIFU is non-invasive and doesn’t require surgical incisions. It is often used in cases of localized recurrence after radiation (salvage therapy), though it is sometimes used as primary treatment in select low-risk patients.
Cryotherapy involves freezing prostate tissue using thin needles inserted through the perineum. Liquid nitrogen or argon gas is used to freeze and kill cancerous tissue.
Like HIFU, cryotherapy is generally reserved for salvage cases, although it may be considered for men who are not good surgical candidates.
It is usually done under anesthesia and requires only a brief hospital stay.
HIFU & Cryotherapy Side Effects
These treatments are less invasive than surgery, but they are not without risks and side effects. Their effectiveness in long-term cancer control is still being studied and may be lower than traditional methods in some cases.
Common side effects of HIFU and cryotherapy include:
- Erectile dysfunction
- Urinary symptoms
- Incontinence (it’s less common than with surgery but can still occur)
- Rectal injury
Because of these risks and the uncertainty of long-term outcomes, these treatments are usually offered in specialized centers and are often part of clinical trials or used when standard therapies have failed or are not an option.
Questions To Ask Your Doctor
- What steps can we take to reduce my risk of side effects?
- How long will I be dealing with incontinence? Erectile dysfunction?
- What if the side effects do not improve over time?
- Is there a treatment path I can take that reduces my risk of side effects?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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