Understand prostate cancer treatment options

Nearly 181,000 men in the United States will be diagnosed with prostate cancer this year, according to the American Cancer Society. When the disease is caught and treated early, it has high survival rates. This means that for many men with prostate cancer, choosing treatment is not so much about choosing a life-saving option as it is about protecting their quality of life after treatment.

Treatment options vary widely, from active monitoring to hormonal therapy, surgery, radiotherapy, chemotherapy, and immunotherapy. Some treatments can cause harmful side effects, including sexual and intimate problems, urinary incontinence, and pelvic pain. Treatment options have come a long way over the years. Learn more about advances in prostate cancer treatment.

Why active monitoring?

For some low-risk men, the recommended approach is active surveillance, that is, monitoring of the disease and its progression. “I recommend active surveillance for 10-15 percent of my patients,” says Evan Pesek, MD, a medical oncologist at The Hospital of Chicago. “Some of them may never need treatment because of the low risk of disease progression, while others may be too sick to receive treatment.” Active surveillance is attractive to some patients because it does not require surgery or hospitalization. But it may require frequent check-ups with your doctor for blood tests, rectal exams and other tests.

Prostate cancer surgery is usually an option for men with early-stage disease. The procedure to remove the prostate is known as a robotic prostatectomy. Possible short-term side effects include shortening of the penis, leakage of urine from the bladder, or stool from the bladder (urinary incontinence). Possible long-term side effects include chronic loss of urine from the bladder and erectile dysfunction.

Hormone therapy reduces the body’s production of testosterone, which stimulates the growth of cancer cells. It comes with a long list of potential short-term side effects, including hot flashes, decreased muscle mass, decreased mental ability, fatigue, depression, impaired sexual function, loss of libido, nausea, diarrhea, itching, weight gain, mood swings, growth Breast tissue and insulin resistance. Over time, some patients may not return to their pre-treatment testosterone levels.

Radiation therapy for prostate cancer involves the use of high-energy beams known as external radiation therapy (EBRT) or radioactive seeds called brachytherapy.

“Frequent urination and mild to moderate burning with urination are basically guaranteed with any form of radiation therapy, including brachytherapy,” says Sean Kavanaugh, MD, chief of radiation oncology at our hospital near Atlanta. “In general, the frequency of urination will increase from mild to moderate.”

What are the other side effects of EBRT?

Other potential short-term side effects of EBRT include fatigue, urine leakage, diarrhea, and abdominal cramps. Possible long-term side effects include erectile dysfunction, changes in bowel habits, secondary cancers in the treated areas, and rectal bleeding. Brachytherapy has the potential in the short term to cause pain, urinary retention and blood in the urine. Possible long-term side effects include erectile dysfunction and urethral strictures.

Chemotherapy includes anti-cancer drugs that are injected into a vein or orally. Possible short-term side effects include hair loss, mouth sores, loss of appetite, increased risk of infection, easy bruising or bleeding, and fatigue. Possible long-term side effects include numbness and tingling, severe allergic reactions, and nerve damage.

Immunotherapy is designed to stimulate the body’s immune system to kill cancer cells. Possible short-term side effects include fever, chills, nausea, vomiting, fatigue, high blood pressure, increased heart rate, anemia, back pain, dizziness, and muscle pain. Most of these side effects are mild to moderate and last one to two days.

For men with prostate cancer, there is no standard treatment approach. That’s why it’s important to know your options and potential side effects. “You have to make a treatment that works for the patient,” Dr. Kavanaugh says. “Patients deserve numbers. They deserve to know the risks they face and what their quality of life will be afterwards.”