Prostate Cancer Treatment Options

Watchful Waiting

Watchful Waiting is the term coined by the medical community to describe an approach for managing cancer that has not yet moved beyond the prostate gland. This approach is also known as “observation” or “surveillance.”

Because cancer in this stage advances very slowly there is the possibility that it will not cause any lifetime problems. This is especially true of older men. Men who opt for this approach do not participate in any active treatment without cause. They visit their physicians for monitoring but unless a problem arises they have no other treatment.

If there are no indications of infection, kidney or bladder damage this can be a reasonable approach. Other obvious advantages to this approach are sparing the man pain and potential side effects related to surgery or radiation.

The downside of this approach is the risk of decreasing control of the disease before it spreads. Another negative factor is postponing treatment until a man is more at risk from the side effects and the difficulty of dealing with the treatment itself. Some men also find that dealing with the stress of having cancer and doing “nothing” about it can cause panic and anxiety.

Watchful Waiting is more viable for older men who have tumors that are very small and growing very slowly as mentioned above in the low-grade Gleason Score.

Some men who opt for this approach have been known to live for years with no outward signs of disease and in several studies for as long as 10 or 15 years, there is no significant difference in life expectancy than those men who were treated with surgery or radiation.

Surgery

There is no doubt about it. Surgery is an invasive procedure. There is evidence that surgery for prostate cancer is rampant in the United States with an increase of 60% between 1984 and 1990. Contrast this with the Watchful Waiting approach used in Europe for the same stage prostate cancer. Recent studies, however, do show a decrease in the number of men having radical prostatectomy procedures.

While the medical community would like to see more incidence of the Watchful Waiting approach, patients find the approach too stressful.

Let’s discuss the actual surgical procedure. It is called a radical prostatectomy and is the complete removal of the prostate as well as tissue nearby. The procedure can be further described by the incision used to accomplish the procedure. These incisions are:

• Retropubic prostatectomy. The prostate is reached via an incision in the lower abdomen;
• Perineal prostatectomy. The prostate is reached via an incision in the perineum which is the space between the scrotum and the anus.

Radical prostatectomy consists of removing the entire prostate gland, the seminal vesicles, both of the ampullae (the enlarged lower sections of the two vas deferens which are the tubes that carry sperm from the testicles to the actual prostate gland) and the other surrounding tissue. The portion of the urethra that travels through the prostate is cut away as well as the bladder neck and some of the sphincter muscle that controls urine flow.

Dissection of the pelvic lymph node is routine with a retropubic prostatectomy but with a perineal prostatectomy the dissection requires a separate incision.

A radical prostatectomy is a serious, complicated, demanding procedure. The surgery itself will take anywhere from 2 to 4 hours. The patient will remain in the hospital for approximately 3 days. He will require a catheter (tube to drain urine) for about 10 days to 2 weeks. There is a small percentage (5 to 10%) of surgical related problems like bleeding or infection. The risk of death from the surgery is very minimal and much less for younger men as opposed to older men who may be frail.

Post surgical, long term problems associated with prostatectomy range from sexual impotence, stool incontinence and urinary incontinence. It is highly unlikely that a man will father children after the procedure. The reason is that without the prostate, very little ejaculate is produced.

It is common for the majority of men to experience incontinence after surgery and men will have occasional dribbling when coughing or exerting themselves. A few will lose all urinary function permanently. Some men are candidates for an artificial urinary sphincter which is implanted surgically or narrowing the bladder opening with injections of collagen.

Stool or fecal incontinence (loss of normal muscle control of the bowels) may affect some men after their prostatectomy. This is caused by muscle damage during rectal surgery and stool incontinence is also caused because of a reduction of the elasticity of the rectum. What this does is shorten the time period between the sensation of the stool and the need to have a bowel movement. The rectum can be scarred and stiffened by surgery or radiation.

Historically, a prostatectomy always resulted in sexual impotence. Advances in surgical procedures called “nerve-sparing surgery” may reduce the risk of impotence. The nerve sparing technique avoids cutting the two bundles of nerves and vessels that run along the surface of the prostate gland that are needed for an erection.

Unfortunately, this procedure is not viable for everyone, if the cancer is too large or if it is located too close to the nerves. Under these circumstances, even with this technique many men (especially older men) will become impotent.

The fact is that most men will lose a degree of sexual function and if a man has a problem with erections before treatment, the nerve-sparing surgery is not indicated.

The chances of impotence run the gamut from 20 to 90% depending on age, stage of the disease and the type of surgery.

Click here if you are currently suffering from prostate health issues. Dr. Sinatra's exclusive, natural, potent prostate health formula may help you. It's my SolveYourProblem recommendation.

by SolveYourProblem.com > Home > Prostate Health Main Page