Prostate Cancer (cont.)
IN THIS ARTICLE
Choosing treatment for prostate cancer can be confusing. Any treatment can cause serious side effects.
Active surveillance may be a good option if you have cancer that is low-risk and has not spread (early stage). With active surveillance, you will have regular checkups with your doctor to see if your cancer has changed.
Active surveillance may also be a good option if you are an older man with serious health problems or close to the end of your life. If this is true in your case, you may not want to have any treatment to remove the cancer. You may decide to have treatment only if it is needed to keep you comfortable (palliative care).
Active surveillance allows a man to wait or avoid treatments that may have serious side effects. But a man who has cancer that is more likely to spread will need to have other treatments such as surgery or radiation unless he is expected to live only a short time.
Your treatment decision will depend on:
Prostate cancer may be curable if it is detected and treated early. Unlike many other cancers, it is usually slow-growing. For most men, this slow growth means they have time to learn all they can before deciding whether to have treatment or which treatment to have.
The side effects of treatment are important to think about. Removing the prostate gland during surgery can cause impotence (not being able to have an erection) and urinary incontinence (not being able to control urination). Destroying the prostate gland with radiation may cause impotence and incontinence, but not as much as surgery can. But radiation sometimes causes diarrhea and bowel problems.5 Hormone therapy can cause loss of sex drive and erections, risk of weak bones (osteoporosis), hot flashes, and weight gain.
The ability to have an erection sometimes returns or at least improves over time. So does the ability to control urine leakage.
A diagnosis of prostate cancer usually means that you will be seeing your doctor regularly for years to come, so it is a good idea to build a relationship that is based on full and honest information. Ask your doctor questions about your cancer so that you can make the best decision about treatment. Your doctor also may give you some advice on changes to make in your life to help treatment be successful.
Your treatment options will be different if you are diagnosed with prostate cancer that has come back or has spread outside the prostate. For more information, see the topic Prostate Cancer, Advanced or Metastatic.
Dealing with your emotions
You may feel many emotions after being diagnosed with prostate cancer. Most men feel some denial, anger, and grief. There is no "normal" or "right" way to react. There are many things you can do to help yourself deal with your emotional reaction to prostate cancer. Talking with family and friends helps some people. Others find that they need to spend time alone.
If your reaction is interfering with your ability to make decisions about your health, talk to your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other men who have had similar feelings can be very helpful.
For more information about specific treatments, see the following topics:
If you choose surgery or radiation to treat your prostate cancer, it will be important to have regular checkups. If your cancer comes back, this will help your doctor catch it early. It will also help your doctor treat any complications you may have from your treatment. Your regular follow-up program may include:
Prostate cancer and its treatment also may cause nausea, pain, or other side effects. You can use home treatment to manage some of these side effects. If you experience nausea, wait for 1 hour after vomiting has stopped and then sip a rehydration drink to restore lost fluids and nutrients. Your doctor may prescribe medicines to control nausea and vomiting. Constipation and diarrhea may be eased if you drink enough fluids.
For more information about managing pain, see the topic Cancer Pain.
If you decide to watch and wait (active surveillance) instead of having treatment, you will have regular checkups with your doctor to check on your cancer. Your checkups may include digital rectal exams, PSA tests, or biopsies. It is possible that a curable cancer could spread and become incurable during a 6-month period, but this is not common. If there is no change in your condition, you may continue active surveillance. If the cancer begins to grow or spread, you may consider medicines, surgery, or radiation.
Treatment if the condition gets worse
For information on prostate cancer that spreads or comes back, see the topic Prostate Cancer, Advanced or Metastatic.
What to Think About
One kind of radiation therapy used mostly in clinical trials is proton therapy. Proton therapy uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which protects nearby healthy tissues (especially the rectum). Sometimes proton therapy is combined with X-ray therapy.
Another treatment is high-intensity focused ultrasound (HIFU), which uses an intense heat from focused sound waves to kill cancer cells. HIFU is also used for men who have cancer inside the prostate but who cannot have surgery. HIFU is a treatment that is used in Canada, Europe, and the United States. In the U.S., HIFU is being used in clinical trials. It is not yet FDA-approved.
Age is not a reason to avoid surgery. But if you are 70 or older, other medical conditions, such as heart disease, may affect your decision. Men who are older also have a higher rate of incontinence and impotence after surgery. Age is especially important to think about if you have early-stage cancer, which generally grows slowly.
Get a second or even a third opinion before making your treatment decisions. You may hear differing advice or opinions, which may seem confusing. But talking with other doctors can help you make your decision. If your doctor is a medical oncologist, you may want to talk with other prostate cancer specialists, such as a urologist, a radiation or urologic oncologist, or a surgeon.
Studies show that fewer side effects are reported at large medical centers, where the surgeons do prostatectomies more often and so are more experienced and skilled.5
eMedicineHealth Medical Reference from Healthwise
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