TheraChoice Prostate Cancer

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  Active surveillance (no treatment)

Why would a man choose active surveillance?

Some prostate cancers do not progress or are very slow growing, therefore may not require immediate treatment. Some cancers may never cause problems for the individual.

Some men do not want to be undergo invasive treatment, or the risks and side effects of treatment outweight the benefits.

What is involved in active surveillance?

Active surveillance, is a form of non-treatment. It involves regular checkups to monitor the progression of your cancer. Treatment is deferred until the the cancer progresses to a point where treatment is highly recommended.

Active surveillance means that you will have periodic digital rectal examinations (DREs), periodic PSA level tests, and additional prostate biopsies, until there is a change.

  • PSA test: every 3-6 months
  • Digital rectal exam (DRE): every 6-12 months
  • Needle biopsy: within 6-18 months after diagnosis

Advantages & disadvantages

Advantages

  • Avoids unnecessary treatment if the cancer was destined to not cause problems
  • No therapy side effects
  • Maintains quality of life

Disadvantages

  • Cancer behavior is unpredictable
  • There is a risk of cancer spread or progression
  • Treatment after cancer progression may be more difficult
  • Treatment side effects after cancer progression may be more complex
  • Increased anxiety
  • Need for periodic medical exams and biopsies (DREs, PSA level tests, biopsies)

This treatment may be appropriate for...

Prostate cancer with very low recurrence risk

  • T: T1C
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Prostate cancer with low recurrence risk

  • T: T1a, T1b, T2a
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Also:

  • Men who discuss with their doctors to not any treatment.
  • Men with less than 10 year life expectancy

  Age

Your current age determines survival rates and life expectancy.

In general, older individuals have a lower life expectancy than younger individuals.

  Androgen deprivation therapy (ADT)

Why would a man choose Androgen Deprivation Therapy (ADT)?

ADT is a type of hormone therapy. It is commonly used to reduce the chance of cancer spreading or returning. ADT can be used in combination with electron beam radiation therapy (EBRT) to delay cancer growth and prolong life.

It may be used alone as the initial therapy for metastatic prostate cancer, or for men with locally advanced disease who can not receive radiation therapy.

What is involved in ADT?

ADT therapy stops the testicles from producing testosterone . The testicles are the main source of testosterone production in the body. The timing of when to start ADT is dependant on the cancer's attributes (stage, grade, PSA level, how fast the PSA level is rising) and the patient's anxiety and concern about the side effects of ADT.

Short-term ADT may he given in combination with electron beam radiation therapy (EBRT) for roughly 4-6 months. Long-term ADT can be used alone to slow the growth and spread of metastatic cancer.

Luteinizing-hormone- releasing hormone (LH-RH) agonist is a type of drug which stops the testicles from producing testosterone. With less testosterone circulating in the body, cancer cells that are dependent on testosterone will grow more slowly.

LHRH agonist drugs are injected or placed under the skin as implants every 3, 4, or 12 months. Hormone therapy may be done at the doctor's office, but some drugs have patient-kits so the administration can be done at home.

Other drugs that are used in hormone therapy include antiandrogens, antiestrogens, antifungal, and steroids.

This treatment may be appropriate for...

Here are a few examples:

  • Men with metastatic cancer
  • Men with late stage cancer who need pain and symptom relief

What happens after treatment?

After the treatment, some men may experience side effects. Well known side effects of ADT include (but do not occur in all patients):

  • Reduced or no sexual desire:libido
  • Hot flashes: sudden rushes of body heat
  • Growth of breast tissue: in estrogen therapy
  • Impotence / erectile dysfunction: inability to get an erection sufficient for sexual intercourse
  • Osteoporosis: weakening of bones (long-term ADT)
  • Fatigue (long-term ADT)
  • Decreased muscle mass, changes in fat distribution (for long-term ADT)

Some side effects are temporary. Certain side effects (such as pain) can be treated, so it is important to be aware of what side effects to expect so you can contact your doctor about symptom relief.

  Antiandrogen therapy

Why would a man choose antiandrogen therapy?

Antiandrogen can be combined with androgren deprivation therapy (ADT) for total androgren blockage. Total androgen blockage is used for advanced stage and metastatic cancers.

Antiandrogen is generally not used alone unless initial therapy with ADT (LHRH agonist) has stopped working.

What is involved in antiandrogen therapy?

Antiandrogen therapy stops the testosterone from interacting with the cells in your body. The testicles are the main source of testosterone production in the body. The timing of when to start antiandrogen is dependant on the cancer's attributes (stage, grade, PSA level, and how fast the PSA level is rising) and the patient's anxiety and concern about the side effects of antiandrogen.

This treatment may be appropriate for...

Here are a few examples:

  • Men with metastatic cancer
  • Men with late stage cancer who need pain and symptom relief

What happens after treatment?

After the treatment, some men may experience side effects. Well known side effects for antiandrogen include (but do not occur in all patients):

  • Growth of breast tissue: with long term ADT
  • Liver disease
  • Diarrhea
  • Fatigue: with long-term ADT
  • Nausea

Some side effects are temporary. Certain side effects (such as pain) can be treated, so it is important to be aware of what side effects to expect so you can contact your doctor about symptom relief.

  Bladder cancer

Why should I be concerned about bladder cancer?

Urinary bladder cancer is cancer that forms in the tissues of the urinary bladder.

What can cause bladder cancer?

Radiation therapy (RT) can increase the risk of bladder cancer. Radiation destroys cancer (and normal cells) by altering a cell's DNA. The DNA (genetic code) of a cell controls how a cell acts and behaves. When you alter the DNA of a cell, it also alters how a cell behaves, so when you radiate a normal cell, it is possible to change a normal healthy cell into an unpredictable cancer cell.

Since the prostate is directly under the bladder, the DNA of cells in the bladder may be affected by the radiation, and become cancerous.

Can this be treated?

Please see cancer.gov or MedLinePlus for more information about bladder cancer.

  Bowel incontinence

Why should I be concerned about bowel incontinence?

Bowel incontinence is the loss of regular bowel (intestine) control.

What can cause bowel incontinence?

In radiation therapy, radiation can damage the rectum (which sits behind the prostate gland). This is because radiation therapy does not specifically target cancer cells, it may also affect healthy cells in your body.

Can this be treated?

Bowel incontinence can be treated by:

  • More surgery
  • Medication
  • Kegel exercises to strengthen pelvic muscles that control fecal release

  Brachytherapy (radiation implants)

Why would a man choose internal radiation therapy (brachytherapy)?

Brachytherapy is a short treatment which can deliver a very large amount of radiation to a very small and focused area. This decreases the amount of damage that is done to surrounding tissues.

Brachytherapy may be used as the primary treatment for early prostate cancer, or with external beam radiation therapy (EBRT) as a boost for later stage prostate cancer.

What is involved in brachytherapy?

Brachytherapy is a type of radiation therapy where 40-100 radioactive seeds are implanted into the prostate. Each seed is roughly the size of a grain of rice. The seeds stay in the prostate and send out low dose radiation in site to destroy cancer cells. In permanent brachytherapy, the seeds lose their radioactivity after a few weeks or months, and the seeds are left in the prostate. This therapy does not specifically target cancer cells. It may also destroy normal healthy cells.

Prior to the procedure, the patient is administered general anesthesia (completely asleep) or local anesthesia (part of the body is numbed). The seeds are placed into thin needles, and inserted through your perineum (between your scrotum and anus), and into the prostate.

Advantages & disadvantages

Advantages

  • Full treatment course length is short

Disadvantages

  • The risk of certain side effects increase over time

This treatment may be appropriate for...

Here are a few examples:

  • Men with early stage cancer that is clinically localized to the prostate gland
  • Men with late stage cancer who need pain and symptom relief
  • Men who are deemed clinically unfit for surgery

What happens after treatment?

An ice pack may be used to reduce the swelling in between the legs. In general, avoid strenuous activity or heavy lifting for the first few days at home, then you may return to normal activity level.

After the treatment, some men may experience side effects. Well known side effects for brachytherapy include (but do not occur in all patients):

  • Bladder injury
  • Rectal injury: burning, pain, diarrhea
  • Impotence / erectile dysfunction: inability to get an erection sufficient for sexual intercourse
  • Incontinence: inability to control urine flow
  • Frequent urination

Some side effects are temporary. Certain side effects (such as pain) can be treated, so it is important to be aware of what side effects to expect so you can contact your doctor about symptom relief.

  Breast tissue growth

Why should I be concerned about breast tissue growth?

Breast tissue growth is when your breast tissue is enlarged. This may be an undesirable change for some men.

What can cause breast tissue growth?

Some hormone therapies can cause breast tissue growth.

  Cancer grade (Gleason score)

The cancer grade is an indication of how aggressive the cancer is.

The Gleason grade ranges from 2 (least aggressive) to 10 (most aggressive.

Cancers that are more aggressive ma spread and/or grow faster than less aggressive cancers.

  Cancer recurrence

Cancer recurrence is the probability that the cancer will return after initial treatment.

It is an uncertain risk factor, however the NCCN guidelines uses T, M, N stages, gleason score, and PSA level to categorize individuals into difference recurrence risk categories.

Some individuals worry about cancer coming back (recurrence) after primary treatment. Adjuvant therapy is treatment that occurs after primary treatment. The goal of adjuvant therapy is to reduce or prevent cancer recurrence.

  Change in appetite

Why should I be concerned about changes in appetite?

There may be some days where you do not want to eat anything, while other days you may want to eat everything. Your sense of taste and smell may also change. Improper food intake can cause tiredness, fatigue, and affect your mood.

What can cause changes in appetite?

All prostate cancer therapies.

Can this be treated?

If you continue to have problems eating, talk to your doctor or a registered dietitian.

  Change or loss in sexual desire

Why should I be concerned about decreased or loss in sexual desire?

The lack or loss of sexual desire can affect you and/or your partner's quality of life.

What can cause a decrease in sexual desire?

Testosterone may be involved in increasing sexual desire, so any hormone therapy that decreases the effect or level of testosterone may cause this side effect.

  Chemotherapy

Why would a man choose chemotherapy?

When cancer has spread beyond the primary cancer site, or when cancer does not respond to hormone therapy, chemotherapy may be considered as a therapy option.

What is involved in chemotherapy?

Chemotherapy uses chemicals to destroy rapidly dividing cells, such as cancer cells. Other normal cells in your body which divide rapidly (blood cells, hair cells, cells lining your gastrointestional tract, etc.) may also be affected and destroyed by chemotherapy.

Chemotherapy is given as a pill, or intravenously (injection into the vein). The drug travels in the bloodstream to the entire body. A drug regime is chemotherapy which involves a combination of several different drugs.

Advantages & disadvantages

Advantages

  • Can kill cancer cells
  • May prolong life

Disadvantages

  • Can damage normal cells
  • Can experience serious side effects

This treatment may be appropriate for...

Metastatic prostate cancer

  • T: any
  • N: N1 or M: M1
  • Gleason score: any
  • PSA level: 10

Also:

  • Men with metastatic cancer, and do not respond to hormone therapy

What happens after treatment?

Side effects for chemotherapy is influenced by the type of drug(s), length of treatment, and amount/dose taken.

After the treatment, some men may experience side effects. Well known side effects for chemotherapy include (but do not occur in all patients):

  • Nausea and vomiting
  • Diarrhea
  • Loss of appetite
  • Numbness
  • Hair loss
  • Mouth sores
  • Low blood counts, increased inction, excessive bleeding or bruising after minor injuries
  • Fatigue: due to lower red blood cell count

Some side effects are temporary. Short-term side effects may disappear after the treatment is complete or stopped. Certain side effects (such as pain) can be treated, so it is important to be aware of what side effects to expect so you can contact your doctor about symptom relief.

  Clinical trials

Why would a man choose to participate in a clinical trial?

By participating in a clinical trial, a man will be receiving a very controlled and specific type of treatment, which a high amount of monitoring and medical attention.

What is involved in a clinical trial?

Clinical trials are research studies that patients can participate in. By participating in clinical trials, patients help researchers make advances in cancer therapy. Clinical trials are carefully controlled and planned. Clinical trial topics include studies which:

  • Test whether a new treatment is safe and effective
  • Determine whether a "refinement" on a standard therapy is better
  • Determine whether one therapy has better outcomes than another therapy

Not all men are eligible for all clinical trials. Some clinical trials recruit a specific patient population. Ask your doctor if you are interested in learning about clinical trials, or you may browse a list of current prostate cancer studies from ClinicalTrials.gov.

Advantages & disadvantages

Advantages

  • Access new research treatments
  • Help other patients by contributing to medical research
  • Access to medical care staff during the trail

Disadvantages

  • Outcomes of new drugs or procedure trials are unpredictable
  • Unknown side effects
  • Unknown life threatening situations
  • Trial treatment may be ineffective
  • Commitment to trial treatment

  Decreased muscle mass

Why should I be concerned about decrease muscle mass?

Decreased muscle mass may be a concern for men who are physically active.

What can cause bowel incontinence?

Since testosterone plays a role in maintaining muscle mass, long term androgen deprivation (hormone therapy) may cause a decrease in muscle mass by lowering the amount of testosterone in your body.

Can this be treated?

A decrease in muscle mass can be treated by:

  • Doing weight-bearing exercises

  Diarrhea

Why should I be concerned about diarrhea?

Diarrhea is when you have more loose or liquid bowel movement. It can cause dehydration, and may be an inconvenience to your every day life.

What can cause diarrhea?

Chemotherapy and hormone therapy.

  External beam radiation therapy (EBRT)

Why would a man choose external beam radiation therapy (EBRT)?

Each radiation treatment session is quick and requires no operation or hospital.

EBRT may be used to relieve symptoms and pain due to cancer metastasis.

What is involved in EBRT?

EBRT is a type of radiation therapy where a machine external to the body sends radioactive waves towards the cancer site to destroy cells. This therapy does not specifically target cancer cells, therefore it may also destroy normal healthy cells.

Your radiation oncologist will create a treatment plan detailing the number of treatment sessions and radiation dose (measured in Gy) involved. For men with early stage prostate cancer, the radiation treatment is repeated 5 days / week, for 2-10 weeks. Men who are using EBRT for metastatic cancer symptom relief have fewer treatment sessions.

Your skin is marked after determining the exact location of your cancer. This ensures that the radiation is delivered to the correct spot each treatment session. You must keep still while the radiation dose is aimed and administered to your body.

Advantages & disadvantages

Advantages (compared to surgery)

  • Avoids the complications in surgery: bleeding, risks associated with anesthesia, need for transfusion
  • Sexual function may be better preserved over the short term

Disadvantages (compared to surgery)

  • EBRT involves up to 41 treatments, spread over 9 weeks, 5 treatment sessions / week
  • The risk of impotence increases over time (longer the treatment duration, the higher the risk)

This treatment may be appropriate for...

Here are a few examples:

  • Men with early stage cancer that is clinically localized to the prostate gland
  • Men with late stage cancer who need pain and symptom relief
  • Men who are deemed clinically unfit for surgery

What happens after treatment?

Each radiation treatment session is short, and does not require hospital stays.

After the treatment, men may experience side effects. Well known side effects for EBRT include (but do not occur in all patients):

  • Urinary bladder damage
  • Rectal damage: diarrhea, blood in stool, colitis
  • Impotence / erectile dysfunction: inability to get an erection sufficient for sexual intercourse
  • Urinary incontinence: frequent urination, urge incontinence, burning sensation while urinating, blood in urine

Some side effects are temporary. Certain side effects (such as pain) can be treated, so it is important to be aware of what side effects to expect so you can contact your doctor about symptom relief.

  Fatigue

Why should I be concerned about fatigue?

Fatigue is physical or mental weakness, or feeling unenergetic and tired. Feeling fatigue may impact individuals who are used to engaging in high energy work or exercise.

What can cause fatigue?

Radiation therapy, androgen deprivation therapy, and antiandrogen therapies can cause fatigue.

Chemotherapy can also cause fatigue because of the lower amount of red blood cells.

Can this be treated?

Fatigue can be treated by:

  • Good sleep and rest

  Hair loss

Why should I be concerned about hairloss?

Hair loss may affect your appearance.

What can cause hair loss?

Chemotherapy can cause hair loss because chemotherapy drugs target cells which divide quickly (such as your hair cells).

Can this be treated?

Hair loss due to chemotherapy treatment is generally temporary. Hair should grow back a few weeks post treatment.

  Have you had any of the following medical problems?

Prior history of the following medical problems determines how healthy you are, which in turn affets survival rates and life expectancy.

Individuals with more disease (potential comorbidities) have a decreased life expectancy.

  Hormone therapy

Hormone therapy

Some prostate cancer cells need hormones to grow and divide. Hormone therapy involve drugs which stop or limit cancer cells from growing. The drugs can do this by depriving the cancer cellsí access to male hormones in the body. Most prostate cancers grow very little without the presence of male hormones.

The most common hormone that prostate cancer cells use to grow are androgens, or more specifically, testosterone. The testicles are the main producers of testosterone in the body, but the adrenal glands also make a lesser amount.

Hormone therapy can be used alone, before, during, or after radiation therapy. It is commonly used to reduce the chance of cancer spread or recurrence.

Types of hormone therapy

  • Androgen deprivation therapy (ADT): stopping the testicles from producing testosterone
  • Antiandrogen therapy: block the effect of male hormones on the body, but do not block their production
  • Total androgen blockage: a combination of ADT and antiandrogen therapy

  Hot flashes

Why should I be concerned about hot flashes?

Hot flashes can make you feel very hot and then very cold, regardless of your environment's temperature. These quick changes in temperature can make you sweat or feel very cold.

What can cause hot flashes?

Hormone therapy.

Can this be treated?

Hot flashes can be treated with:

  • Low doses of estrogen or progesterone-like drugs

  Impotence

Why should I be concerned about impotence?

Impotence is also known as erectile dysfunction. It is the inability to develop or maintain an erection. This condition can impact a man's sex life.

What can cause impotence?

In prostatectomies, the nerves and blood vessels surrounding the prostate gland may be damaged or removed, which can in turn lead to impotence.

In radiation therapy, radiation can damage the nearby nerves and blood vessels surrounding the prostate gland.

Changes in hormone levels in hormone therapy can also cause impotence.

Can this be treated?

Impotence can be treated by:

  • Drugs such as Viagra, Levitra, and Cialis can help improve erections
  • Vacuum devices, mechanical pumps
  • Prostaglandin E1 is a drug that is injected or put into the urethra as a suppository before sexual intercourse)
  • Poresthesis, penile implants

  Inguinal hernia

Why should I be concerned about an inguinal hernia?

An inguinal hernia is when part of the small intestine or body fat budges through a muscle weakness, and into the groin.

What can cause an inguinal hernia?

An inguinal hernia is more likely to occur if a man had some other form of therapy that could damage muscles around the pelvis.

Can this be treated?

Inguinal Hernia can be treated with:

  • More surgery

  Laparoscopic prostatectomy

Why would a man choose laparoscopic prostatectomy

Some men want the cancer physically "removed" from their body. Smaller incisions are used in this procedure, which heal faster compared to open surgery (radical and perineal prostatectomy).

Treatment length is short. Some men do not want to be committed to long term therapy.

What is involved in laparoscopic prostatectomy?

Laparoscopic prostatectomy is a type of surgery where a urologist removes the prostate and some surrounding tissue. This procedure uses a thin tube-like camera called laparoscopes which are inserted into the body. Thin long instruments are inserted into other small incisions on the abdomen to remove the affected tissue.

Roughly 5 small incisions are made on the abdomen. The surgeon will look at the nerves surrounding the prostate gland. Some of the nerves surrounding your prostate gland are responsible for erections. If the cancer has not spread to the nerves, the surgeon will try to keep the nerves in place and not damage them (nerve sparing procedure).

A robot-assisted prostatectomy (robotic prostatectomy) procedure is when a doctor operates by controlling a system made up of 2-3 robotic arms and a laparoscope. Robotic arms can make more precise movements compared to a surgeon's hand, but may lack the sense of touch that can affect a surgeon's performance.

The surgeon's experience is important, so you may ask the surgeon how often he/she performs the procedure each month, and whether the surgeon has a personal complication rate.

Advantages & disadvantages

Advantages

  • considered less invasive than retropubic and perineal prostatectomies
  • Smaller incisions heal more quickly than open surgery

Disadvantages

  • Removal of the prostate gland means that other arrangements must be made if the man wants to father children (sperm banking before surgery, sperm-retrival procedure after surgery)
  • Risk of incomplete tumor removal

This treatment may be appropriate for...

Prostate cancer with very low recurrence risk

  • T: T1C
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Prostate cancer with low recurrence risk

  • T: T1a, T1b, or T2a
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Prostate cancer with Intermediate recurrence risk

  • T: T2b
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Also:

  • Men with cancer that is clinically localized to the prostate gland
  • Men who are deemed clinically fit for surgery

What happens after treatment?

On average, patients will stay in the hospital for a 2-3 days post surgery. Then a patient will be sent home with a urinary catheter in place to allow the connection between the bladder and urethra to heal. The urinary catheter allows the urine in the bladder to drain into a bag that is strapped to the thigh. After the connection between the bladder and urethra has healed, the catheter is removed.

After the treatment, men may experience side effects. Well known side effects for prostatectomy include (but do not occur in all patients):

  • Overflow urinary incontinence: difficulty with emptying urinary bladder
  • Stress incontinence: releasing a small amount of urine when laughing, coughing, sneezing, or exercising
  • Impotence / erectile dysfunction: inability to get an erection sufficient for sexual intercourse

Some side effects are temporary. Certain side effects (such as pain) can be treated, so it is important to be aware of what side effects to expect so you can contact your doctor about symptom relief.

  Liver disease

Why should I be concerned about liver disease?

Liver disease can be any type of damage or abnormality related to your liver or its function. Your liver is a vital organ that is responsible for many things, such as detoxification and making proteins for digestion. The liver is necessary for long term survival.

What can cause liver damage?

Antiandrogen hormone therapy.

Can this be treated?

Please consult your doctor if you are experiencing liver problems.

  Low blood count

Why should I be concerned about low blood count?

Low blood count can lead to increased infection, fatigue, and excessive bleeding or bruising after minor cuts and injuries.

What can cause low blood count?

Chemotherapy can cause low blood count because the chemotherapy drugs target and kills fast dividing cells, such as your blood cells. With less blood cells, your body can feel fatigue (less oxygen circulating) and infections may increase (less immune cells in your system).

Can this be treated?

Low blood count can be treated with:

  • Drugs that boost blood cell counts

  M-category

M stands for metastasis

Lymph node represents the extent to which the cancer has spread to distant parts of the body.

A higher M-stage means that the tumor has spread to more distant tissues an/or organs.

  M-category tests

A M-stage test determines if the cancer has spread to other parts of the body (beyond the prostate).

Test results from physical examinations, imaging studies (X-rays, CT scans, MRI scans, PET scans) and/or laboratory tests can help determine the N-stage of your cancer.

  N-category

N stands for lymph node

Lymph node represents the extent to which the lymph nodes in your body are involved.

A higher N-stage means that the tumor has spread to a higher number of lymph nodes.

  N-category tests

A N-stage test determines if the cancer has spread to the lymph nodes.

Test results from physical examinations, imaging studies (X-rays, CT scans, MRI scans, PET scans) and/or laboratory tests can help determine the N-stage of your cancer.

  Nausea and/or vomiting

Why should I be concerned about nausea and/or vomiting?

Nausea is the feeling of motion sickness, unease and discomfort in the upper stomach, and the urge to involuntarily vomit.

Vomiting (throwing up) is the forceful expulsion of stomach contents through the mouth and/or nose.

What can cause nausea?

Antiandrogen therapy and chemotherapy can cause nausea.

Chemotherapy can cause vomiting

Can this be treated?

Nausea and vomiting can be treated with:

  • Antinausea drugs
  • Antivomiting drugs

  Numbness

Why should a I be concerned about numbness?

Numbness is the loss of feeling or sensation in a part of your body. It can be caused by nerve damage or irritation. Numbness can become dangerous because you can be injured without realizing it.

What can cause numbness?>

Surgery, chemotherapy, radiation therapy, and hormone therapy.

Can this be treated?

Talk to your doctor about way you can regain feeling in numb areas.

  Osteoporosis

Why should I be concerned about osteoporosis?

Osteoporosis is when the bones in the body begin to deteriorate, causing bones in the body to weaken. If your bone density decreases, you are at an increased risk of bone fractures.

What can cause osteoporosis?

Hormone therapy and Chemotherapy can cause osteoporosis.

Can this be treated?

Osteoporosis can be treated with:

  • Calcium supplements
  • Vitamin D supplements
  • Drug therapy to strengthen bones

  Pain

Why should I be concerned about pain?

Pain can be persistent or sudden, dull or intense. Feeling pain can also lead to fatigue or cause you to feel unenergetic and unable to carry out daily activities. Feeling pain may impact individuals who are used to engaging in high energy work or exercise.

What can cause pain?

All therapies can cause pain. Sometimes the pain is temporary, or it may be long term.

Can this be treated?

Pain can be treated with:

  • Pain medication

  Pelvic lymph node removal

Why would a man choose to combine prostatectomy with pelvic lymph node removal

If the cancer is suspected of (or has) spread to the lymph nodes in the pelvis, your surgeon may recommend removing the lymph nodes before cancer spreads further, or to lower the risk of cancer recurrence.

What is involved in pelvic lymph node removal?

Pelvic lymph node removal, or lymphadenectomy, is usually performed at the same time as a prostatectomy. However, if a man has chosen to have an operation for radical perineal prostatectomy, another incision in the abdomen is required to remove the affected pelvic lymph node(s).

This treatment may be appropriate for...

Prostate cancer with very low recurrence risk

  • T: T1C
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • b>PSA level: less than 10

Prostate cancer with low recurrence risk

  • T: T1a, T1b, or T2a
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Also:

  • Men with confirmed or suspected cancer spread to lymph nodes
  • Men who are deemed clinically fit for surgery

  PSA level

PSA (Prostate Specific Antigen) level is measured in ng/mL.

It can be used as an indicator of cancer.

  Radiation therapy

Radiation therapy (RT)

Radiation therapy (RT) can be used to treat prostate cancer that is clinically localized to the prostate gland, or if it has spread to nearby tissues, such as the bladder, rectum, or urethra.

It uses high-energy rays (X-rays, etc) or particles (electrons, protons, etc.) to kill cancer cells. Sometimes it is used to decrease the size of a tumor or relieve pain due to cancerous growth in bones.

Types of radiation therapy

  • External beam radiation therapy (EBRT): radiation comes from a machine outside the body, and is focused to a particular location in the body
  • Brachytherapy (implant/internal radiation): seeds are inserted and left in the prostate to give off radioactivity
  • Systemic radiation: for body wide control of cancer cells

  Radical perineal prostatectomy

Why would a man choose radical perineal prostatectomy

Some men want the cancer physically "removed" from their body.

Treatment length is short. Some men do not want to be committed to long term therapy.

What is involved in radical perineal prostatectomy?

Radical perineal prostatectomy is a type of surgery where a urologist removes the prostate gland and some surrounding tissue. The surgeon's experience is important, so you may ask the surgeon how often he/she performs the procedure each month, and whether the surgeon has a personal complication rate.

An incision is made between in the perineum (between the scrotum and anus).

Advantages & disadvantages

Advantages

  • Short treatment length

Disadvantages

  • Removal of the prostate gland means that other arrangements must be made if the man wants to father children (sperm banking before surgery, sperm-retrival procedure after surgery)
  • Nerve sparing operations are more difficult
  • Used less commonly than retropubic approach
  • Lymph nodes can not be removed through this incision

Who might be appropriate for this treatment?

Prostate cancer with very low recurrence risk

  • T: T1C
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Prostate cancer with low recurrence risk

  • T: T1a, T1b, or T2a
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Also:

  • Men with cancer that is clinically localized to the prostate gland
  • Men who are deemed clinically fit for surgery

What happens after treatment?

On average, patients will stay in the hospital for a 2-3 days post surgery. Then a patient will be sent home with a urinary catheter in place to allow the connection between the bladder and urethra to heal. The urinary catheter allows the urine in the bladder to drain into a bag that is strapped to the thigh. After the connection between the bladder and urethra has healed, the catheter is removed.

After the treatment, men may experience side effects. Well known side effects for prostatectomy include (but do not occur in all patients):

  • Overflow incontinence: difficulty with emptying urinary bladder
  • Stress incontinence: releasing a small amount of urine when laughing, coughing, sneezing, or exercising
  • Impotence / erectile dysfunction: inability to get an erection sufficient for sexual intercourse

Some side effects are temporary. Certain side effects (such as pain) can be treated, so it is important to be aware of what side effects to expect so you can contact your doctor about symptom relief.

  Radical retropubic prostatectomy

Why would a man choose radical retropubic prostatectomy?

Some men want the cancer physically "removed" from their body.

Treatment length is short. Some men do not want to be committed to long term therapy and their side effects.

What is involved in radical retropubic prostatectomy?

Radical retropubic prostatectomy is a type of surgery where a urologist removes the prostate and some surrounding tissue. The surgeon's experience is important, so you may ask the surgeon how often he/she performs the procedure each month, and whether the surgeon has a personal complication rate.


An incision is made on the lower abdomen. The surgeon will look at the nerves surrounding the prostate gland. Some of the nerves surrounding your prostate gland are responsible for erections. If the cancer has not spread to the nerves, the surgeon will try to keep the nerves in place and not damage them (nerve sparing procedure).

Advantages & disadvantages

Advantages

  • Nerve sparing operations are easier compared to radical perineal prostatectomy
  • More commonly used approach than perineal approach
  • Lymph nodes may be removed through this incision

Disadvantages

  • Removal of the prostate gland means that other arrangements must be made if the man wants to father children (sperm banking before surgery, sperm-retrival procedure after surgery)

This treatment may be appropriate for...

Prostate cancer with very low recurrence risk

  • T: T1C
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Prostate cancer with low recurrence risk

  • T: T1a, T1b, or T2a
  • N: N0
  • M: M0
  • Gleason score: less than 6
  • PSA level: less than 10

Also:

  • Men with cancer that is clinically localized to the prostate gland
  • Men who are deemed clinically fit for surgery

What happens after treatment?

On average, patients will stay in the hospital for a 2-3 days post surgery. Then a patient will be sent home with a urinary catheter in place to allow the connection between the bladder and urethra to heal. The urinary catheter allows the urine in the bladder to drain into a bag that is strapped to the thigh. After the connection between the bladder and urethra has healed, the catheter is removed.

After the treatment, men may experience side effects. Well known side effects for prostatectomy include (but do not occur in all patients):

  • Overflow urinary incontinence: difficulty with emptying urinary bladder
  • Stress incontinence: releasing a small amount of urine when laughing, coughing, sneezing, or exercising
  • Impotence / erectile dysfunction: inability to get an erection sufficient for sexual intercourse

Some side effects are temporary. Certain side effects (such as pain) can be treated, so it is important to be aware of what side effects to expect so you can contact your doctor about symptom relief.

  Rectal cancer

Why should I be concerned about rectal cancer?

Rectal cancer is cancer that forms in the tissues of the rectum (part of the intestines which stores feces).

What can cause rectal cancer?

Radiation therapy (RT) can increase the risk of rectal cancer. Radiation destroys cancer (and normal cells) by altering a cell's DNA. Since the prostate is directly in front of the rectum, cells in the rectum may be affected by the radiation, mutate, and become cancerous..

Can this be treated?

  Surgery

The most common surgery for prostate cancer is called radical prostatectomy

Surgery involves physical removal of cancer tissue or organs. This may involve the removal of a part of, or the whole prostate, and/or removal of lymph nodes in the pelvis, which is called lymphadenectomy.

Radical prostatectomy is an operation where a surgeon (urologist) removes the whole prostate gland, and possibly some surrounding tissue.

During operation, patients are under general anesthesia (asleep) or local anesthesia (awake, but part of the body is numb) with sedation.

Types of radical prostatectomy

For radical retropubic prostatectomy the skin incision is made in the lower abdomen.

For radical perineal prostatectomy the skin incision is made between the anus and scrotum.

Radical laparoscopic prostatectomy is considered a minimally-invasive surgery because it uses several tiny incisions in the abdomen.

  Survival

Why should I be worried about the survival outcomes of a treatment?

Survival may be very important to you if you want the therapy that maximizes your life expectancy.

Survival rates show how many individuals remain alive after each consecutive year.

The following diagram is a representation of the relative survival rate of breast cancer patients. It is a general depiction of survival, because it includes all ages, all treatments, and all types of prostate cancer.

5 year survival rate for Prostate cancer patients

Your doctor should be able to provide you with a more personalized survival estimate, based on your particular cancer characteristics, health, age, and more.

  T-category

T stands for tumor. It represents the size and extent of the tumor, relative to the prostate gland.

A higher T-stage means that the tumor is larger and/or spreading within and/or beyond the prostate gland.

T1

T1a, T1b, T1c

T2

T2a, T2b, T2c

T3

T3a, T3b

T4

  Therapy side effects

Why should I worry about therapy side effects?

A side effect is an unintended consequence of a therapy. Some side effects are minor, and will go away with time. Some side effects linger, and can affect how you function or feel in your everday life.

Therapy side effects are different for each therapy and combinations of therapies. If you survive cancer, keep in mind that you may be living with the side effects of your treatment. Side effects can have a negative impact on your quality of life, so the advantages and disadvantages of each therapy must be weighed by the you and your health care provider(s).

  Therapy treatment course

Each person's cancer therapy is unique.

Therapy options in Therachoice's treatment tree are based on the National Comprehensive Care Network's clinical practise guidelines for Prostate cancer.

Using this tool will help you understand the different options that may be available to cancer patients like you. However, your doctor(s) may have alternative recommendations because they have a deeper understanding of your cancer and health.

  Therapy treatment length

Why should I worry about treatment length?

Some people lead very active or busy lifestyles, and do not want to be committed to very long or frequent therapies.

Some therapy side effects increase or become more severe with prolonged treatment.

Treatment length is further broken down into:

  • Length of a single treatment session or procedure
  • Repeatability: does this treatment/procedure happen more than once? Or does it repeat on a schedule? How many times do I have a treatment session?
  • Full treatment course: the time needed to complete the entire therapy

  Tumor flare

Why should I be concerned about tumor flare?

Tumor flare is a short term worsening of cancer symptoms, such as pain or fatigue.

What can cause tumor flare?

LHRH agonist (hormone therapy) can cause tumor flare when it is first administered, but this side effect is generally temporary.

  Urinary incontinence

Why should I be concerned about urinary incontinence?

Urinary incontinence is the involuntary leakage of urine.
Stress incontinence is when a small amount of urine leaks when coughing, sneezing, laughing, or exercising. It is caused by damage to muscles at the base of the urinary bladder.
Overflow incontinence is when the bladder is difficult to empty because connection between the bladder and urethra is obstructed, usually by scarring.
Urge incontinence is the feeling of needing to urinate all the time.

What can cause urinary incontinence?

After removing the prostate in prostatectomies, the connection between the bladder and urethra must heal. While the connection is healing, a man may experience urinary incontinence. Most men will experience temporary urinary incontinence immediately after surgery.

In radiation therapy, radiation can damage the nearby muscles and nerves associated with the control of urine flow.

Can this be treated?

The symptoms of urinary incontinence can be relieved by:

  • More surgery
  • Medication
  • Kegel exercises to strengthen pelvic muscles that control urine release
  • The use pads to absorb any urine leakage