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In last month's Healthy Aging column, "Prostate Cancer; A Problem for Older Men," we discussed the fact that as men age their chances of developing prostate cancer increase.  This is the reason that an annual medical exam should specifically include methods of detecting prostate cancer.  Statistically speaking, one out of three men who do have cancer will have prostate cancer.  Thus, it is vital to consider the treatment for this common and very treatable disease.

The first and most important recommendation about prostate cancer treatment is to get information about the therapies available from one's primary physician and a team of specialists who work in this field.  The team is usually a urologist and a radiation oncologist.  Both of these specialists have expertise in surgical and radiation approaches to therapy, respectively, and both are knowledgeable about the treatments of the other.  In fact, it does not always come down to either/or in choosing an approach, but the team may be involved for follow-up care after of either type of approach.  There are other sources of information, including your friends and family who may have had to decide on therapy.  There are two excellent sources useful in understanding the various treatment options: these are American Cancer Society and the National Cancer Institute.  A local source of information can be found from the Hollings Cancer Center web site.  As with any discussion of therapy, the goal is to identify the risks and benefits to treatment and tailor these to your particular needs with the aid of your doctor and family. 

General Approach 
There are three main approaches to the treatment of prostate cancer.  These are:

1) Surgery
2) Radiation Therapy
3) Cryotherapy

The three general approaches have good results, that is, there is a 15 year survival rate over 60 % in the first two and possibly that high in the third.  The final decision of what therapy to choose is based on these considerations; extent and type of cancer, age of the patient, general health of the patient, desire (preference) of the patient.  Obviously, these factors are best considered with the assistance of a physician who knows the patient and his medical history.

Surgery
There are two surgical approaches to prostate cancer, they are different anatomically and in terms of complications as well as probable long lasting cure.  The first and now most commonly used in younger patients is radical retropubic prostatectomy and the other is transurethral resection of the prostate.  Both require anesthesia, a hospital stay and varying surgical complications from the surgery itself such as infection, heart attack or other complications, including those from anesthesia.  All of these complications are relatively rare.  More common are after affects of bladder function, urinary function, and sexual function.  Both surgical approaches over the long term can produce problems with the urinary tract such as obstruction of urine flow, and the retropubic approach has a higher incidence of incontinence and impotence.  There relate to the larger extent of the surgery.  This more extensive surgery is considered to have a higher chance of cancer cure, and for this reason is used in younger and healthier men. 

Radiation
There are also two types of radiation therapy approaches to prostate cancer.  One is external beam and the other is brachytherapy or interstitial radiation.  As the names indicate external radiation is done non-invasively usually over the course of several weeks while brachytherapy requires anesthesia, usually a short hospital stay and is an internal or invasive form of radiation done usually only one time.  Both approaches do have side affects in relation to bladder and bowel function as well as some urinary tract and sexual function.  The incidence of incontinence is very rare and impotence is less with radiation than radical prostatectomy.  Radiation is usually the choice of older patients with less aggressive disease or patients with multiple other medical problems that increase the risks of surgery. 

Cryotherapy
Is a newer approach to treatment and therefore the long-term outcome is less well understood.  Nevertheless, it is a proven approach to the disease and the results are promising.  This therapy requires anesthesia and involves "freezing" the prostate and killing cancerous cells.  There is an incidence of incontinence after this that is comparable to radical prostatectomy but the importance and urinary tract complications are similar to brachytherapy therapy. 

How to Decide? 
The decision of treatment of prostate cancer is a very personal decision.  It is a cancer that has multiple approaches with different potential complications but also different cure rates.  The good news is that although this is a common cancer in men it is not a common killer of men.  The reason for this is the several exceptionally good therapies.  Nothing makes cancer a welcome diagnosis, but the many modern approaches to prostate cancer make it one that you can expect to cure.  The selection of specific therapy is up to you, your physician and your family. 

MUSCHealth.com Online Health Library Related Links:
Cancer Center Health Resource Library: Prostate Cancer

Other Online Resources Related to Prostate Cancer:
MUSC Hollings Cancer Center
Medline Plus Information Related to Prostate Cancer
American Cancer Society
Us Too! International

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