Over 200,000 American men are diagnosed with prostate cancer each year. After skin cancer, it is the most common cancer amongst American men. Fortunately, there are many options for treatment, from prostate surgery to hormonal treatments to simple watchful waiting. More good news is that most prostate cancers are detected early and can be treated effectively to either cure the cancer or prolong patients lives and increase their quality of life as well.
For men who have low Gleason scores, low PSA levels and small tumors, or for those of advanced age or poor health, watchful waiting is often the best treatment for prostate cancer. Prostate cancer is generally slow growing, so for men of advanced age or poor health, the cancer may never develop into a problem before death. For those with lower Gleason scores, low PSA levels and/or small tumors, having a physician monitor the cancer and its growth often gives the patient time to consider the options such as prostate surgery or hormonal treatment, should more aggressive treatment become necessary.
For those patients whose cancer is significant enough to warrant treatment, but the cancer is contained to the prostate and the patient is in good health, prostate surgery is often the best option. The goal of prostate surgery is to remove the cancer from the body. There are several different types of prostate surgery to consider if you are in this position. The types of surgery all have the same end goal, but some have different side effects than others.
Traditional surgeries such as retropubic, suprapubic and perineal prostatectomies carry risks related to all open surgeries such as blood loss, infection at the incision site, as well as the side effects unique to prostate surgery - impotence and incontinence. With traditional non-nerve sparing surgeries - 65 to 90 percent of men will become impotent. About 10 percent will become incontinent.
There are, however, other options for prostate surgery - most notably nerve-sparing robotic prostatectomy. In this technique, the surgeon uses the assistance of a robotic instrument to remove the prostate, while sparing the nerves associated with both urinary control and erectile function. Studies have shown that ninety-four percent of men return to full urinary control within a year and eighty percent regain full erectile function within eight months.
For those whose cancer has spread beyond the edge of the prostate, hormonal therapy is often the best treatment option. It is also appropriate for those whose cancer returns after prostate surgery. Testosterone stimulates the growth of prostate cancer cells, so the goal of hormone treatment is to reduce the amount of testosterone in the body to slow the growth of the cancer cells.
One hormone treatment of note is DES, or diethylstilbesterol. DES works to block the production of testosterone, without causing bone loss. This is key because many of the other drugs used in hormone treatment of prostate cancer cause significant bone loss, which can lead to other problems. Some people may associate DES with clear cell adenocarcinoma, but it has been shown that clear cell adenocarcinoma only affects females who are exposed to DES.
The key to finding the best treatment is determining what stage your cancer is at and what side effects you are willing to accept for the benefit of treatment. While being informed is important, only you and your doctors can make the final decision as to which treatment is right for you.