Much like women going to menopause, many men fear aging and the associated prostate troubles that come along with it.
Some of the more common situations linked of prostate problems include erectile sexual dysfunction, difficulties and
a low libido.
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Treatment of early stage localized prostate cancer
According to many experts, men with prostate cancer are less likely to receive clear information about their
choices than other cancer patients. Men and their families must be awared that not all treatments are suitable
for everyone. It is particularly important that men with eary etage localized disease to know the potential side
effects of each treatment option.
1. Watchful waiting - active surveillance
Here, the patient receives no treatment, but doctors keep a close eye in case the cancer starts to become more aggressive. Active surveillance involves attending a special clinic every three to six months to have Prostate Specific Antigen (PSA) levels checked and other tests carried out. Patient may also have a repeat biopsy.
In many cases, men can live with slow-growing prostate cancer for their entire lives, so no need for invasive treatment or surgery. The big problem is possibility for cancer to suddenly become very aggressive and this may not be picked up immediately.
Active surveillance is particularly useful for men with low-risk prostate cancer who are more elderly. It is not generally recommended for younger men with this disease below the age of 60 because they have potentially longer life spans when the cancer can become a problem.
2. External beam radiotherapy (EBRT)
A high dose of radiation is directed on to the diseased prostate using a computer-aided external beam. This makes it more accurately focused so the cancer is targeted and destroyed, but the surrounding healthy tissue is unharmed. Intensity Modulated Radiation Therapy (IMRT) is a newer form of this radiotherapy. It sends out concentric beams of radiation, like an onion skin, focusing the highest dose in the middle of the tumour and the lowest dose at the edge of the prostate.
Less invasive than surgery, EBRT can cure the cancer lowering risk of urinary incontinence after treatment. Side effects are short-term bladder and bowel irritation and in the case of 1 in 20 men, these can persist. Rates of sexual dysfunction after EBRT are similar to surgery - 40 per cent.
EBRT is particularly suitable for men who have localized prostate cancer (low, medium or high risk) and who don't want to have the prostate removed; patients where the cancer has spread outside the prostate.
3. Brachytherapy
Around 100 radioactive seeds are inserted into the prostate gland via needles using a general anesthetic or epidural. The seeds give off radiation at a low dose rate over a period of several weeks or months destroying cancer. Even becoming ineffective, they are never removed. This treatment is more convenient to the patient than giving radiation therapy because it only involves two hospital trips.
Side effects and cure rates are the same as for EBRT. Can cause long-term problems including difficulty passing urine and getting and maintaining an erection.
It is suitable for men who have small growing cancers.
4. Radical prostatectomy
This is the most common surgery for treating early stage of prostate cancer and involves removing the entire prostate gland and some surrounding tissue under general anesthetic.
If the cancer is completely removed, so a complete cure is possible and gives more than 90 per cent chance of enjoying a further 10 years of high-quality life after surgery. The rates of success depend of experience and skills of surgeon. Average blood loss is 1 liter and 20 per cent of men need transfusions. A catheter will need to be fitted for up to three weeks. Around 50 per cent of men suffer erection problems.
Prostatectomy is suitable for men whose cancer has not spread beyond the gland with better results for men who have a PSA score under 15. Can be also suitable for men who have locally advanced prostate cancer.
A machine called the Da Vinci robot is now being used to improve accuracy of prostatectomy removing the gland through small holes (around 1cm) in the abdomen. This new technology reduces blood transfusion rates to just 1 per cent.
High intensity focused ultrasound (HIFU)
Treatment using ultrasound energy to heat and destroy cancer tumor in its early stage. Under general anesthetic, a probe is inserted into the rectum; this emits high frequency sound waves on to the prostate. A balloon, also inserted via the rectum, is filled with cooling water to protect the tissue of the rectum from burning.
Sexual potency is maintained as the whole prostate is not removed and the nerve supply is left intact. As prostate is not completely removed, HIFU may miss cancerous cells elsewhere in the prostate. Catheter needed for up to ten days to let the prostate heal.
HIFU is still under evaluation so statistics do not show how effective this is at curing cancer.
HIFU is particulary suitable for men with low-risk prostate cancer unhappy with just active surveillance treatment.
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