Lesson 3: Prostate Cancer Treatment Options
Surgery
When discussing treatment options with Urologists, they will tell you that surgery is the "Gold Standard" by which all other treatments are measured. A successful treatment is one where there is 10% or less chance of cancer recurrence within 20 years.
There are several aspects to be evaluated when considering surgery:
The patient will need to know whether the doctor thinks he can use a nerve-sparing or non-nerve sparing technique, and whether the surgery will be done open or laparoscopically. Both open and laparoscopic techniques have different success rates, and different side effects. The non-nerve sparing technique allows the Urologist to take a wider "margin" around the cancer, decreasing the chance of any of the tumor being left behind, and the subsequent need for salvage radiotherapy. However, this technique increases the risks of impotency and incontinence.
Some surgeons take samples of tissue from the lymph glands to assure that the cancer has not spread to them.
Laparoscopic techniques are new to the scene and long-term outcomes are unknown, but many Urologists are offering it up as "miracle surgery" -- highly effective with lessened recovery times. The latter is true, but the former has not been established yet so this technique still remains experimental.
The Retropubic approach: The surgeon cuts horizontally across the abdomen to access the prostate. This technique is used when it is felt that the lymph nodes also need to be removed.
The Perineal approach: The surgeon enters via an incision between the scrotum and the rectum. The recovery time is less for this technique.
Some surgeons are practicing new techniques that allow them to cut away the cancer and leave the nerves intact. These nerves are the ones that allow the man to have an erection. These nerves are part of the outer wall of the prostate so the chances of saving these nerves are reliant upon the location of the cancer within the prostate. If the cancer is well away from the outer walls the chances of being able to spare the nerves are better. Likewise, the cancer may be localized in one side of the prostate and the surgeon may be able to save the nerves on the unaffected area. The value you put on having and/or maintaining an erection is an individual thing that only you and your sex partner can evaluate.
Side effects of surgery: During the operation the surgeon will cut the urethra from the bottom of the bladder and it will be reattached. This procedure disrupts the nerves that send the message that it is time to urinate and/or to stop urinating. A catheter is normally inserted through the penis and into the bladder after surgery. The catheter is kept in place for 10 days to three weeks to help facilitate urination during healing. A large percentage of the men will have a troubling 6 weeks, after which the nerves should be healed and acting normally. The men outside of this group will have to learn to live with incontinence. Fortunately, there are medications and other aids to assist men in this group.
All men should be aware that infection is always a risk with any surgery. Some men have ongoing problems if the infection gets into the lymph glands in and around the prostate area, and may require prolonged treatment with antibiotics or may even require further surgery.
