Treatment of prostate cancer
CANCER IS DEFINED as disordered or abnormal cell growth, with the potential to invade or spread to other parts of the body. In prostate cancer, cells grow out of control and form tumours.
When the tumour is confined within the gland it is localised and curable, when it escapes the gland it is advanced or metastasised. Treatment of prostate cancer is available at all stages. All prostate cancers do not behave the same.
Some are slow growing and may not require any treatment, whilst some may grow and spread rapidly and require treatment.
Treatment options for localised prostate cancer include:
1) Active surveillance
2) Surgery – radical prostatectomy
3) Radiotherapy – external beam radio therapy or brachytherapy
Before any treatment of prostate cancer is considered, one takes into account a patient’s life expectancy, other medical co-morbidities, and the risk of the prostate cancer spreading (by interpreting the grade/ volume of the cancer from the biopsy and the PSA).
For low-risk cancers, and sometimes in older individuals where the cancer has a lower risk of progressing in one’s lifetime, active surveillance can be considered. In this approach these low-risk cancers are monitored by way of PSA blood tests and prostate biopsies at serial intervals.
This gives an indication of whether the cancer is growing significantly and if this occurs curative treatment such as surgery or radiation can then be employed. With this approach the side effects of treatment for those cancers that may be “slow-growing” can be avoided.
Radical prostatectomy (surgery) involves complete removal of the prostate and surrounding lymph nodes when necessary. This can be done conventionally by open surgery or in a minimally invasive fashion (robotic or laparoscopic).
The main benefit of surgery is the ability to remove all of the cancer. Once the disease has not spread, this offers the possibility of freedom of prostate cancer for a lifetime.
Long-term side effects of surgery include erectile dysfunction and incontinence, which may occur.
Radiotherapy for prostate cancer involves radiation energy to the prostate to kill prostate cancer cells. This can be delivered by an external source or by radioactive seeds implanted into the prostate (brachytherapy).
Radiotherapy is less invasive than surgery but the disadvantage is that it leaves the prostate inside the body. Side effects of radiation in relation to surrounding structures are bowel and urinary complications.
In advanced or metastatic prostate cancer (spread outside the prostate), all is not lost as these cases can also be treated. Testosterone in the body feeds prostate cancer cells.
Medication can thus be used to block or decrease the testosterone so as to decrease or “shrink” the prostate cancer cells. This is known as hormonal or androgen deprivation therapy.
This method is for advanced cases and although not curative, it relieves symptoms of advanced cancer and definitely improves quality of life. Side effects of this treatment include hot flashes, erectile dysfunction, and breast swelling.
Prostate cancer is a significant health problem in Barbados. The management and treatment of prostate cancer is dependent on the pros and cons of each different method discussed with one’s urologist.
Dr Jeetu Nebhnani, MBBS, DM (Urology), is a consultant urologist and uro-oncologist, Queen Elizabeth Hospital, Cariburol Inc.