If you are lucky, your cancer may grow at a prolonged rate and not need any treatment. However, most people have faster-growing prostate cancers which need treatment – sometimes immediate. This is especially true if they have one of the rare and fast-growing types of prostate cancer which are aggressive. Your doctor will keep in mind the following points before discussing and deciding upon a treatment plan with you:
- The stage, severity and extent of the cancer
- The risk of your cancer
- Your age and physical condition/health
- What your goals are and the types of treatments you would prefer
Depending upon the stage and extent of your cancer, you may be asked to undergo other diagnostic tests. These tests will influence your doctor’s treatment plan while it may seem tempting to opt for immediate and radical treatment which will bring immediate results and remission. Keep in mind that this generally involves heavy doses of chemotherapy which can adversely affect your life in both the short and long-term. Additionally, many of the medicines that are used to treat prostate cancer are powerful, and all have side effects which can make you very sick.
It is better to take a second or third opinion from a good urologist. This will help you plan out the best course of treatment with your doctor. You will heal faster and stay healthier longer if you make radical lifestyle adjustments with your therapy. This includes regular exercise, quitting smoking, limiting alcohol, eating right, and minimizing stress. If you feel angry or depressed because of your cancer and treatment, remember to see a psychologist, psychiatrist or both because good mental health will help you recover faster and stay in remission longer.
Surgery
If your Gleason and TNM scores are high enough, you may need to have surgery to remove part or all your prostate. The operation only removes the affected areas, which include the lymph nodes and a little bit of surrounding tissue (to remove any new cells which may have or be spreading!). This surgery for prostate cancer is known as radical prostatectomy and can be done in two ways:
- With robots
- Through an incision in your abdomen
With robots
If your doctor chooses this option, he or she will put a robot which contains instruments needed for the surgery into your abdomen. The doctor will then use a remote control to have the robot operate. Because the surgery is entirely mechanical, it is the least invasive and most accurate one with the highest success and survival rates. Hence, it is a very effective treatment method for prostate cancer.
Through an incision in your abdomen
This is called retropubic surgery. If your doctor does this type of surgery, he or she will make an incision in your lower abdomen and remove your prostate.
Radiation
This is a powerful and toxic energy which is designed to kill prostate cancer cells. Doctors use two types of chemotherapy to fight prostate cancer:
- External beam radiation
- Brachytherapy
External beam radiation
You will lie down while a machine will send x-ray beams all over your body. These beams are designed to kill the cancer cells.
Hormone therapy
Sometimes, surgery and chemotherapy are not enough. You will need various treatments which will stop new cancer cells from being created. Hormone therapy can accomplish this. You get this because it shuts down testosterone production – testosterone is what gives the cells in your prostate (including cancer cells) the energy and nourishment they need to grow. Your cancer will go into remission for longer, and you will be healthier if your doctor includes therapies which don’t allow new cancer cells to thrive as part of your treatment plan.
Three main types of hormone therapy exist:
- Medicines that shut down testosterone production
- Medications which keep testosterone from nourishing cancer cells
- Orchiectomy – this surgery gets rid of your testicles
Medicines that shut down testosterone production
This suite of medications is known as Luteinizing Hormone-releasing hormone (LH-RH) agonists. They block the messages which your brain sends to your testicles to produce and release testosterone. All testosterone production shuts down as a result. Many drugs are on the market (all prescription) which are used to do this. Some of them are Leuprolide, Goserelin, and Triptorelin.
Medicines which keep testosterone from nourishing cancer cells
These are anti-androgens. They stop testosterone from providing the energy and nutrients cancer cells need to grow. Some of these medicines include Bicalutamide, Nilutamide, and flutamide. If these don’t work, your doctor may rely on the potent drug Xtandi as a last resort.
Orchiectomy
If your doctor takes your testicles out entirely, your overall testosterone production levels will immediately drop dramatically.
Note that these types of hormone therapy are used as a last resort therapy and only for men with prostate cancer that is in the advanced stages. If you have later-stage prostate cancer, your doctor may choose this because it is effective in reducing the size of the tumours, which makes them more likely to be killed off by chemotherapy.
Brachytherapy
Your doctor will load many nodules with radiation energy which he or she will place the buds inside your body. These nodules will gradually emit low doses of radiation energy which will kill the cancer cells. The buds are inserted with a laparoscopic needle which is guided with an ultrasound. You don’t need to worry about surgery to get rid of these nodules because they ‘die out’ and become harmless with time.
Freezing prostate tissue
This is referred to as cryoablation/cryosurgery, and it is beneficial because it kills cancer cells by freezing them. If your doctor performs this procure, he or she will insert tiny needles into your prostate. Ultrasound images will guide him or her for accuracy and effectiveness. The needles are full of cold gas which freezes the surrounding tissue. The doctor will immediately reheat the tissue using another gas. This process must be repeated multiple times to be effective.
Chemotherapy
You will be given a cocktail of potent, radioactive medicines. These are effective in killing cells that grow too fast. You can get them through an IV, or you can take them like a pill. Chemotherapy is enough if cancer has metastasized or if other treatment options aren’t viable or successful.
Biological therapy
Doctors refer to this as immunotherapy because it uses your immune system to kill cancer cells. It’s a brand-new therapy with very high success rates and the least amount of side effects. You will likely be given Provenge (a powerful biological therapy medicine) which is very effective at sending prostate cancer into remission should relapses occur.
Your doctor will use a blood draw to obtain some of your immune cells. He or she will then genetically engineer them to kill prostate cancer cells. The new immune system cells work wonders when reintroduced into your body!
Complications
If you have surgery, you run the risk of having difficulty urinating, and trouble with erectile dysfunction. Chemotherapy is potent and can kill or damage healthy cells, along with the cancer cells. You may lose hair or weight or feel very sick as a result. You may also have urinary incontinence or pain when urinating. Some significant side effects of chemotherapy include erectile dysfunction and diarrhea. Also, hormone therapy, while useful, is not a Godsend. It has its painful side effects which include erectile dysfunction, hot flashes, bone mass loss and reduction in libido, and weight gain.
Cryosurgery is not used much because of its extreme riskiness and many acute side effects.
Side effects
You may find that your bladder leaks as a result of your treatment plan. Urination can be painful, and you may require permanent kidney dialysis because of complete loss of bladder control. You may end up waking up many times during the night to urinate with radiation treatment.
Bowel dysfunction or slower-moving stools is a common side effect of prostate cancer treatments. This is because the inside of your rectum can be damaged by some of the more invasive procedures. You may have diarrhea, bloody stools, or a sudden urge to defecate, only to find that no stool is produced.
Hormone therapy, while it produces wonderful results, can have serious side effects. These include hot flashes, decreased libido, bone density and mass loss, osteoporosis, erectile dysfunction, fatigue, weight gain, reduced muscle mass, anemia, loss of memory, and higher (harmful) cholesterol levels. Your risk of developing diabetes and getting heart attacks also increases dramatically.
Surgery can increase your survival chances, but its side effects can also be severe. You will likely have urinary incontinence for some time after your surgery. This can be alleviated with pelvic floor muscle exercises. Erectile dysfunction and problems with bowel movements are common side effects. Many men have issues with fertility after surgery. You will not be able to ejaculate sperm during sex, so your partner will not get pregnant. If you want to have kids after surgery, consider storing and freezing substantial quantities of sperm before your operations.
Chemotherapy consists of powerful medicines and has its own side effects. These include an immediate fever and lower white blood cell counts (so chemotherapy weakens your immune system!) You may also experience numb and weak feet, fingers, and toes. Please note that this side effect is usually permanent. You may also have neuropathy which tends to be stable as well. If you receive regular chemotherapy, your blood platelet count will decrease dramatically. You will be more prone to bleeding and will bleed for longer because you will have fewer blood platelets to stop the bleeding. Approximately one per cent of chemo patients will have problems with this.
Chemotherapy has other devastating and potentially severe side effects which include anemia (5%), increased risk of heart failure (10%), hair loss (65%), diarrhea (32), changes in nail colour, consistency, quality and thickness (30%), decreased desire to eat (20%), being short of breath (15%), edema (10-20%).
Managing side effects
Since many of these side effects can be life-threatening, they need to be managed early on to increase your chances of survival. Most of these side effects, when treated within the stipulated time, are harmless. This is discussed in further detail below.
If you have problems urinating, your doctor will likely prescribe you medicine to help with this. Some effective medications include Tamusulosin, terazosin, and alpha-blockers. These are very effective at reversing urinary incontinence. You will generally be prescribed these medicines during or after radiation therapy. You’ll need to take them for a while to be effective. Your doctor will gradually wean you off them as your urination abilities improve.
Doctors have found that medicines like tolterodine and solifenacin are great at treating any bladder irritation can be due to the treatment. These drugs belong to a class known as anticholinergic medicines. If you can’t urinate at all, it takes a long time for you to do so, or it is excruciating, your doctor may prescribe you collagen injections. These are injected into your urethra or urinary hole. Because it makes your hole smaller and tighter, it prevents these problems and urinary leakage problems. It works in half of the patients, but its benefits do not last long.
You may need surgery if your urinary problems are severe because this is a more effective management method. The effects last much longer. One type of surgery requires your surgeon to place a sling made either out of prosthetic material (generally speaking), or natural tissue (rarely) under your urethra. This device is attached to a surrounding muscle or bone to secure it into place. The sling is very effective in reducing urinary incontinence and bladder leakages because it relieves the pressure on your urethra as your bladder fills up. This surgery is referred to as prostatectomy and is successful in 70% of cases.
After treatment
Your journey is only just beginning after your treatment plan is completed because you must figure out how to relive your life. While relapse is rare, it is not unheard of. You’ll need many years of follow up care as a result. Your doctor will introspect you about many points related to your overall health and quality of lifestyle during these visits. He or she will do many lab tests and other exams to check the levels and quality of cells in your prostate and bloodstream.
You will undergo imaging tests for the doctor to determine the exact state of your prostate.