Surgery (Radical Prostatectomy)
 The whole prostate is removed with the seminal vesicles (which produce semen), the deferent canals, part of the bladder neck and the surrounding lymph nodes. This surgical intervention is invasive and involves the use of general anesthesia for 3 to 4 hours. Hospitalization is for a number of days. At the localized prostate cancer stage (stages T-1 or T-2) a radical prostatectomy can be curative, but it usually results in impotence and can result in moderate to severe urinary incontinence. As in any other major surgery, radical prostatectomy may have complications and may require a prolonged recovery time. External Beam Radiation Therapy (EBRT) This treatment involves the use of radiation (very high-energy rays) directed at the prostate using a special machine. Radiotherapy does not require anesthesia and the treatment is usually done on an outpatient basis. Patients are usually treated five days per week in a cancer clinic over a period of seven or eight weeks with each session lasting a few minutes. Complications include marked inflammation of the bladder and/or rectum, as well as impotence as a late complication (6 to 12 months after treatment). Late side effects can also include soilage of stool because of damage to the rectal sphincter. Recurrent cancer after EBRT is not uncommon and is very difficult to treat. Other radiation treatments are Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT). Brachytherapy During brachytherapy many (sometimes 100's) small radioactive seeds are implanted directly into the prostate gland using 20 - 40 needles. This procedure is usually done under general anesthesia (2 to 3 hours). It is recommended that the patient avoid close contact with children and pregnant women for months after seed implant. As with EBRT, recurrent disease is not uncommon and is difficult to treat. Brachytherapy cannot be utilized when a patient has symptoms of prostate obstruction, when he has a high Gleason stage, or when he has had a previous transurethral resection of the prostate (TURP). Cryotherapy Cryotherapy, guided by ultrasound, the prostate is frozen solid. Ultrasound guidance controls the extent of the freeze. The procedure is done under anesthesia and requires at least an overnight stay in the hospital. This technology has improved in recent years but is still associated with a very high incidence of impotence and urinary incontinence. In addition, fistulae (or holes) between the prostate and rectum can occur, especially in patients who have had unsuccessful EBRT. There are also a large number of patients who undergo cryotherapy after unsuccessful EBRT who experience pelvic and/or rectal pain. |
