MANAGEMENT AND TREATMENT

What are the complications of prostate cancer?

Some aggressive cancers quickly spread (metastasize) outside of the prostate. Prostate cancer most commonly spreads to the bones and lymph nodes. It can also develop in the liver, brain, lungs and other organs.

How is prostate cancer managed or treated?

Some people never need treatment because the cancer grows slowly and doesn’t spread. With treatment, most prostate cancer is highly curable. Treatment options include:

• Active surveillance: With this approach, you get screenings, scans and biopsies every one to three years to monitor cancer growth. Active surveillance works best if the cancer is only in the prostate, slow-growing and not causing symptoms.
• Watchful Waiting: Watchful waiting sounds similar to active surveillance, but is often used in older or frailer patients. Similar to active surveillance, this approach does not involve definitive treatment at diagnosis. However, the testing is much less frequent, and focuses on symptom management.
• Brachytherapy: A form of internal radiation therapy, brachytherapy involves placing radioactive seeds within the prostate. This approach helps preserve surrounding healthy tissue.
• External beam radiation therapy: With external beam radiation therapy, a machine delivers strong X-ray beams directly to the tumor. Intensity-modulated radiation therapy is a form of external radiation therapy that delivers powerful doses of radiation to the disease site.
• Systemic therapies: Your provider may recommend systemic therapies if cancer has spread outside of the prostate gland. These therapies include chemotherapy, androgen deprivation hormone therapy and immunotherapy.
• Focal therapy: Focal therapy is a newer form of treatment focusing on treating only the area of the prostate affected by cancer. You may be able to try this treatment if cancer hasn’t spread. Focal therapy options include high-intensity focused ultrasound (HIFU), cryotherapy, laser ablation and photodynamic therapy.
• Prostatectomy: This surgical procedure removes the diseased prostate gland. Surgeons can perform laparoscopic prostatectomy and robotic radical prostatectomy through small abdominal incisions. These procedures are less invasive than an open radical prostatectomy, which requires a larger abdominal incision, although both are effective in cancer removal.

What are prostate cancer treatment side effects?

Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:

• Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isn’t full. This problem can improve over the first six to 12 months without treatment.
• Erectile dysfunction (ED): Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two (sometimes sooner). In the meantime, medications like sildenafil (Viagra®) or tadalafil (Cialis) can help by increasing blood flow to the penis.
• Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a woman’s uterus.