Localised Prostate Cancer

Treatments if you have localised prostate cancer

Watchful Waiting or Active Surveillance: 
If a patient has an elevated PSA, but no evidence of prostate cancer from biopsy and other tests, he is likely to be put on Watchful Waiting with a regular PSA test every six months to watch and to see the progress of his prostate cancer.

 

Radical Prostatectomy: 
If a patient is a younger man i.e. in his 50-60’s and the cancer is contained within the prostate gland this is a recommended form of treatment. This is often performed by a Robot, (robotic surgery performed with a da Vinci Robot) or laparoscopic (keyhole surgery), in order to make the procedure less invasive and with a faster recovery from the surgery.

Robotic da Vinci surgery is now widely available and should be considered as an important treatment option.

 

Brachytherapy:
 If the cancer is low volume prostate cancer contained within the prostate, the use of this form of radiotherapy using either radioactive seeds or the newer HDR High Dose Brachytherapy (without seeds) is an excellent way to treat the prostate cancer. Likely to cause no problems with urination and less problems with impotence. It has one of the highest established cure rates of any treatment and requires no medication after treatment.

 

Radiotherapy: Dependent on the opinion of the oncologist, radiotherapy will be given where this is regarded as the appropriate form of treatment for prostate cancer. It is usually given over 7 week period (five day week) once per day. Improvements are continually being made. Modern IMRT Radiotherapy  machines are able to take an X-ray image just before the treatment, sometimes three gold seeds are inserted into the prostate, the gold seeds are used to target the treatment precisely. This means the beams can be smaller, reducing the amount of beam to nearby healthy organs, the bladder and rectum. PROSTaid is currently sponsoring the cost of these “gold seeds” for local patients .

 

Alternative treatment options:

HIFU High intensity focused Ultrasound
: Again if the cancer is low volume prostate cancer contained within the prostate gland, this form of treatment using a probe in the rectum and high intensity focused ultrasound can be an effective way of treating prostate cancer. The advantage is that it can be used a number of times. It is widely used in Europe and was developed in France.

Cryosurgery
: This treatment, uses Ice balls, formed by inert gases on the tips of needles to form together larger ice balls to destroy the affected tissues. It can be used as a primary treatment, but is more likely to be used as a “salvage” treatment when Radiotherapy has failed and the cancer returns. It is often successful

 

Will the Treatments Affect me?


As patients, we have to be open and honest. Most of the treatments in order to treat the cancer will have an affect on your life. These are  principally impotence (the ability to have an erection), and occasionally incontinence (control over urination).

Active Surveillance
You will not be affected

Radical  Prostatectomy
In the majority of cases the removal of the prostate gland will make you impotent and unable to have an erection. However, in some cases it is possible to have a nerve sparing procedure, particularly in robotic surgery. This could help to keep you potent, ask your hospital doctor for details.  Drugs like Viagra, Cialis or a pump can also be of great  help. There is a possibility of incontinence, although in the majority of cases this is often temporary and is soon restored. If incontinence continues to be a problem,  a sling,  or an artificial sphincter can be surgically fitted by an Andrologist.

Radiotherapy
In the majority of cases this will make you impotent. Also there is  the possibility that it sometimes can give you incontinence and urgency problems. Occasionally it may affect  the tissue in your rectum. However with newer IMRT (Image Guided Radio Therapy),  these problems can be reduced or avoided, especially if gold seeds are inserted in the prostate to ensure that any shift in the prostate can be automatically corrected before the radiotherapy is given.

Bracytherapy
With this type of treatment there is a better chance that your will continue to be potent and have no incontinence problems. However, the cancer must have been caught early enough to allow Brachytherapy.

HIFU
With this type of treatment there is also a better chance that you will continue to be potent and have no incontinence problems, However, the cancer must have been caught early enough to allow HIFU.

Can my sexual function be restored?
You need to see an Andrologist who specialises in sexual function treatments  & incontinence. In most cases there are treatments available to help restore sexual function. These range from oral  drugs, such as Viagra and Cialis, to drug pellets to insert in the penis, which are self-administered, drug injections, vacuum pumps and surgically inserted penile implants.

Sometimes, da Vinci Robotic surgery can carry out ‘nerve sparing’ surgery, which will greatly reduce these side affects.

What about Incontinence
Yes this can be treated and controlled. There is something better than pads! Ask to see an Andrologist. Treatments range from oral  drugs to reduce urgency and frequency, simple pelvic floor exercises, the  surgical installation of a sling,  or an artificial sphincter.