The 3 Best Prostate Cancer Treatments
Protect your prostate
When it comes to treating prostate cancer, there’s more good news than you might think. The most effective treatments carry a cure rate of about 90 percent when the cancer is caught early and confined to the prostate, as 75 percent of them are when diagnosed.
What’s more, treatments are improving. A brand new National Cancer Institute clinical trial combined androgen deprivation therapy—medication that limits the body’s ability to produce prostate cancer-fueling testosterone—with radiation therapy. The combo significantly improved the 10-year survival rate among men with intermediate-risk prostate cancer, a type that’s more likely to spread.
But if you have just been diagnosed with early-stage prostate cancer, what are the most effective treatments out there today? Here are your best options.
Surgery
Medicine is not yet able to identify where, exactly, cancer is hanging out in your golf-ball sized gland (though science is moving in that direction). So most surgical treatments involve a radical prostatectomy—removal of the prostate gland. There are currently two ways to get the job done. The first is with traditional open surgery, which involves making an incision in the lower abdomen. The second is with minimally invasive surgery where the surgeon uses special instruments to perform the operation through a handful of tiny keyhole sized incisions. Robotic-assisted surgery is a type of minimally invasive surgery that is becoming an increasingly popular option.
“The bottom line with radical prostatectomy is that the surgeon’s experience matters more than the technique,” says Eric Klein, M.D., Chairman of the Cleveland Clinic Glickman Urological and Kidney Institute. “At the Cleveland Clinic, the outcomes after prostatectomy—cure, preservation of continence and potency, pain, and recovery time—are almost identical between open and robotic surgery. You want to find the most experienced surgeon you can and have the type of surgery that that surgeon is most adept at performing.” Want to get even more specific? Look for someone who has performed over 200 prostatectomies. Data suggests you’re most likely to get an optimal outcome after a surgeon has achieved that magic number.
Generally, surgery is a preferable treatment for younger men (with prostate cancer, that means younger than mid-60’s) because your body has a better chance at resolving side effects such as impotence and incontinence. However, it can be slow-going—if the nerves important for sexual function are injured during surgery, it can take 2 to 3 years before they’re fully healed, says David Chen, M.D., a urologic oncologist at the Fox Chase Cancer Center in Philadelphia. The upside: With surgery, it’s possible to have no long-term effects. That’s not always the case with other treatments.
More from MensHealth.com: Coping with Prostate Cancer
External Radiation Therapy
Radiation therapy involves using high-energy X-rays or particles like protons to kill cancer cells and shrink tumors. These days, it’s becoming a more refined science than simply point-and-shoot. “With intensity modulated radiation therapy, we’re able to split up the beams into lots of different beamlettes, each with a slightly different intensity, so the higher intensity beams target the thicker areas of the prostate and the lower intensity beams cover the thinner areas,” says Andrew Lee, M.D., M.P.H., associate professor of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston. “With protons, we can also deliver radiation with more control inside a patient. This results in a higher dose to the prostate and a lower dose to more sensitive areas like the bladder and rectum.
A typical course of radiation involves 40 daily weekday treatments over 8 weeks. Scientists are currently investigating the safety of administering higher doses of radiation in fewer treatments—about five to 10 instead of 40, which could become an option in a few years.
Short-term, the risks of radiation are few. However, since radiation causes collateral damage to nearby healthy tissues, there are concerns down the road. “In 10 to 20 years you may still be cured of prostate cancer, but the radiation may have caused bladder or rectal damage that can cause dysfunction in voiding, which can have a serious impact on your quality of life,” Dr. Klein says. You may develop erectile issues a couple of years later. (ED meds may help.)
Internal Radiation Therapy
If schlepping to the hospital 5 days per week for 8 weeks to receive external radiation sounds like the biggest commitment you’ve made since marriage, you could have the radiation come to you with brachytherapy.
Here’s how it goes down: In a 90-minute outpatient procedure, while you kick back under general anesthesia, your surgeon uses a long, thin needle to implant 100 or so radioactive seeds, each about the size of a grain of rice, throughout your prostate. The seeds emit low doses of radiation that kill neighboring cancer cells. The radioactivity dissipates over several months, and in most cases the seeds are left in permanently. (You can’t see or feel them.)
“The greatest advantage of brachytherapy is convenience,” Dr. Lee says. Overall, the risks are comparable to external radiation, though you may need to take a few extra precautions with your radioactive crotch. “During sex, you could excrete the seeds into your partner, so we recommend wearing a condom,” Dr. Lee says. “And if you have a small child, it’s not a good idea to sit them on top of your lap while the seeds are initially active.”
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