You’ve been diagnosed with Prostate cancer , but before you decide to have a radical prostatectomy (removal of the prostate) do you understand all of the treatment options?
After decades of over treatment we now better understand the treatments and non -treatments available for Low to intermediate risk localised prostate cancer (PCa).
However sadly new research and approaches can take years to be implemented despite a case for change. To avert the risk of making ill-informed decisions it makes sense to ask our oncologists lots of questions and be informed about all the risks and consequences of our choices in treating PCa. However they might not be aware of recent studies and evidence that would open up more choices to you. If there’s even a slight risk we are receiving outdated advice it could result in regrettable outcome we can’t reverse. To avoid this we can do our own independent research and consult more than one specialist for a second opinion. Here’s the latest information of treatments for localised low to intermediate risk PCa.
In a 10 year UK trial, three groups of men were assigned to either surgical removal of the prostate (553 men), radiation treatment (545 men) or active monitoring (545 men). After ten years, the total number of deaths due to any cause was 55, 55 and 59, respectively in each group.
Thus 90% of men were still alive after ten years, including those who did not receive any radical intervention. Although surgery delayed the development of metastases (or secondary cancers) in a small number of men, the number of deaths definitively attributable to prostate cancer in each of the groups was low, only three, four and seven deaths respectively. So the odds of dying specifically from prostate cancer in the first ten years is of the order of 1%.
Age is also a factor in treatment options. If your life expectancy is less than 10 years the advice now is do nothing because you are more likely to die from something else other than PCa.
However , as clear from the UK Trial, active monitoring / surveillance results in the same outcome as surgery or radiation treatment for localised PCa.
Source (Ian Haines, Professor, AMREP Department of Medicine, Alfred Hospital, Melbourne & Senior Medical Oncologist and Palliative Care Physician, Melbourne Oncology Group, Cabrini Haematology and Oncology Centre, Wattletree Road, Malvern, Monash University2017)
According to John Hopkins School of Medicine Radiation beam therapy is as effective as radical prostatectomy for the treatment of low to intermediate risk localised prostate cancer (PCa).
Treatment Side Effects.
The side effects from surgery are more severe than radiation and often include permanent erectile dysfunction (ED). About 80% of men have ED at 6 months and at 5 years and also potentially years of urinary incontinence – 50% of men still need a pad at 6 months, 20% of men maybe wearing a pad at 5 years.
For radiation therapy, incontinence is an infrequent problem. “Approximately 5% of men use a pad at 6 months after radiation therapy and that’s steady at about 5 years. A potential late side effect for urinary function can be the development of a stricture at 10 years or more after radiation, causing it difficulty in urination. After external beam radiation therapy approximately 75% of men have erectile dysfunction at 6 months and at 5 years. ” Ken Panta, Professor of Urology and Oncology at the Johns Hopkins School of Medicine.
What is localised PCa? –
Tumor has not spread outside the prostate.
The tumor can be on both sides or one side of the prostate but has not breached the prostate or entered the seminal vesicles or lymph nodes.
What is low risk PCa?
What is intermediate risk localised PCa?
Clinically Localised: Intermediate-Risk Prostate Cancer find as T2b-T2c or Gleason score 7 or PSA 10-20 ng/ml. The or here is very important, it means that a man is classified as having Intermediate-Risk Prostate Cancer by any one of these criteria. T2b refers to a cancer that is more than half of only one side of the prostate. T2c is cancer in both sides of the prostate.
What is active monitoring/surveillance?
Active surveillance is when the patient choose no treatment and regular checks , which may includes all or some of these: digital examinations , PSA tests and Biopsies , ultra sound, MRI.