Prostate Cancer Treatment

Different types of treatment options are available for patients with prostate cancer; they depend on various factors including the type of cancer and the stage and grade at which it has been diagnosed as well as the age and general health of the patient. Conventional medical treatment options for prostate cancer include:

Expectant management, watchful waiting, and active surveillance for prostate cancer

Because prostate cancer often grows very slowly, some men (especially those who are older or who have other major health problems) might never need treatment for their cancer. Instead, their doctor may suggest approaches known as watchful waiting, expectant management, observation, or active surveillance.

Some doctors use these terms to mean the same thing. For other doctors the terms mean something slightly different:

• Active surveillance is often used to mean watching the cancer closely with PSA blood tests, digital rectal exams (DREs), and ultrasounds at regular intervals to see if the cancer is growing. Prostate biopsies may be done as well to see if the cancer is starting to grow faster.
• Watchful waiting (observation) is sometimes used to describe a less intense type of follow-up that may mean fewer tests and relying more on changes in a man’s symptoms to decide if treatment is needed.

Surgery for prostate cancer

Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the gland.The main type of surgery for prostate cancer is known as a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it. A radical prostatectomy can be done in different ways.

Open approaches to prostatectomy

In the more traditional approach to doing a prostatectomy, the surgeon operates through a single long cut (incision) to remove the prostate and nearby tissues. This type of surgery, sometimes referred to as an open approach, is now done less often than before.

• Radical retropubic prostatectomy: In the retropubic approach, a cut is made in the lower belly (abdomen), as shown in the picture below. The doctor will then remove the prostate and some nearby tissues. He or she can also remove nearby lymph nodes to check for cancer spread.A small tube (catheter) will be put in your penis to help drain your bladder after surgery. The catheter usually stays in place for 1 to 2 weeks while you are healing.

You will probably stay in the hospital for a few days after the surgery, and your activities will be limited for about 3 to 5 weeks.

• Radical perineal prostatectomy: In the perineal approach, the surgeon makes the cut in the skin between the anus and the scrotum. This approach is used less often because it’s more likely to lead to erection problems and because the nearby lymph nodes can’t be removed. But it might be an option if you aren’t concerned about erections and you don’t need lymph nodes removed. It also might be used if you have other medical problems that make retropubic surgery hard to do.

The perineal approach often takes less time than the retropubic approach, and may result in less pain.A tube for draining urine (called a catheter) will be put into the bladder through the penis to drain urine for 1 to 2 weeks while you are healing.You will probably stay in the hospital for a few days after the surgery, and your activities will be limited for about 3 to 5 weeks.