Prostate Cancer Treatment : You have been diagnosed with prostate cancer & the following will outline treatment options.

There are different options for managing and treating prostate cancer. For some men immediate treatment is not required or may not be appropriate. Your treating specialist will advise you of your options based on your age, general health, the stage and grade of the prostate cancer, the severity of symptoms and the likely side effects of treatment.

Active surveillance:  is a way of monitoring prostate cancer that isn’t causing any symptoms or problems and is considered to be low risk. Typically, active surveillance involves regular PSA tests every 3-6 months, multi-parametric MRI scans when indicated & biopsies at regular intervals. If at any stage the cancer shows signs of change then active treatment will be discussed.

Active surveillance may be a preferred option if the possible treatment side effects would have more impact on your quality of life than the cancer itself. Active surveillance may also be suggested if the cancer is small (low volume) and slow growing (low grade) and is thought unlikely to spread. 

Watchful waiting: Watchful waiting is another method of monitoring prostate cancer. This involves regular PSA tests and clinic check-ups. The monitoring process is less strict than for active surveillance and further biopsies are not usually required.

Watchful waiting may be suitable for older men where the cancer is unlikely to cause a problem in their lifetime. Some men choose watchful waiting instead of immediate cancer treatment if the cancer is already advanced. It can also be an option for men with other health problems where treatments such as surgery or radiotherapy may not be appropriate.

Cancer treatment can be considered if the cancer spreads and/or causes symptoms. The aim of treatment is to treat symptoms that may be causing problems rather than cure the prostate cancer.

Radical prostatectomy: Surgical procedure which aims to remove the cancer completely. This involves the removal of the prostate gland, part of the urethra and the seminal vesicles, which store semen. For more aggressive cancer, the adjacent lymph glands may also be removed (pelvic lymph node dissection).

Radical prostatectomy may be performed using different surgery techniques:

Open radical prostatectomy: An open radical prostatectomy is usually done through a small cut in the lower abdomen. After the prostate is removed, the urethra is rejoined to the bladder. You will need to stay in hospital for several days to recover. A thin tube (catheter) will be used to collect your urine in a bag, which may feel uncomfortable. The catheter will be removed 6–14 days after the surgery.You may have some side effects from the surgery (see list below). Depending on your work and lifestyle, you should be able to return to your usual activities within 4–6 weeks and most men can resume driving within a couple of weeks. Heavy lifting should be avoided for six weeks.
Robotic assisted radical prostatectomy: click for more information
Nerve-sparing prostatectomy: Sometimes your surgeon may offer a nerve-sparing radical prostatectomy. This involves removing the prostate and seminal vesicles and trying to preserve the nerves that control erections. This procedure is only considered if the cancer is not in or close to these nerves. This procedure is more suitable for lower grade cancers and may not be possible with higher grade cancers. Erectile dysfunction remains common even if nerve-sparing surgery is performed but may respond better with medication eg Cialis or Viagra. Whichever surgical approach is used, a radical prostatectomy is major surgery and requires time to recover.
Men usually return to normal activities within 2–6 weeks. There is currently no good, long-term evidence that one approach is better than the other or leads to fewer side effects or better cancer outcomes.
Side effects of prostate cancer surgery:

These operations may cause some or all of the following side effects:

  • Nerve damage: The nerves needed for erections and the sphincter muscle required for bladder control are both very near the prostate and cause problems with erections and urinary continence due to the surgery.
  • Loss of bladder control: Following surgery and the removal of the catheter it is common to have some degree of urine incontinence. This condition usually improves within a few months following the surgery, but may take up to one year to fully recover. There are exercises to assist with these problems, and we encourage seeing a physiotherapist before your surgery and after surgery. Undertaking the recommended pelvic floor exercises before and after surgery can influence post-surgery bladder control. bout 5% of men may have ongoing and troubling incontinence that could need surgical intervention at a later time once full recovery is reached. 
  • Erectile dysfunction (impotence): Majority of men experience impotence (erection problems) after prostate surgery. It may take months to a few years for erections to improve and stabilise. Many men may not recover strong erections. Oral medications, injection therapy or surgery for inflatable penile prosthesis may help if you have ongoing problems with erections.
  • Infertility: As the tubes from the testicles (vas deferens) are sealed and the prostate and seminal vesicles are removed, semen is no longer ejaculated during orgasm. This is known as a dry orgasm and results in infertility. Most men are able to reach orgasm with stimulation following surgery.
  • Penile shortening: Some men report a decrease in penis length after surgery.