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Treatment
Getting a Second Opinion
Treatment Methods
Many men with prostate cancer want to take an active part in making decisions
about their care. It is natural to want to learn all you can about prostate
cancer and your treatment choices. However, shock and stress after the
diagnosis can make it hard to think of everything you want to ask your doctor.
It often helps to make a list of questions before an appointment.
To help remember what the doctor says, you may take notes or ask whether you
may use a tape recorder. You may also want to have a family member or friend
with you when you talk to the doctor - to take part in the discussion, to take
notes, or just to listen.
You do not need to ask all your questions at once. You will have other chances
to ask your doctor or nurse to explain things that are not clear and to ask for
more details.
Your doctor may refer you to a specialist, or you may ask for a referral.
Specialists who treat prostate cancer include
urologists,
urologic oncologists,
medical oncologists, and
radiation oncologists.
Before starting treatment, you might want a second opinion about your diagnosis
and treatment plan. Many insurance companies cover a second opinion if you or
your doctor requests it. It may take some time and effort to gather medical
records and arrange to see another doctor. Usually it is not a problem to take
several weeks to get a second opinion. In most cases, the delay in starting
treatment will not make treatment less effective. To make sure, you should
discuss this delay with your doctor. Some men with prostate cancer need
treatment right away.
There are a number of ways to find a doctor for a second opinion:
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Your doctor may refer you to one or more specialists. At cancer centers,
several specialists often work together as a team.
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NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby
treatment centers. Information Specialists also can provide online assistance
through
LiveHelp at http://www.cancer.gov/cis.
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A local or state medical society, a nearby hospital, or a medical school can
usually provide the names of specialists.
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The American Board of Medical Specialties (ABMS) has a list of doctors who have
had training and passed exams in their specialty. You can find this list in the Official
ABMS Directory of Board Certified Medical Specialists. This Directory
is in most public libraries. Also, ABMS offers this information at
http://www.abms.org. (Click on "Who's Certified.")
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NCI provides a helpful fact sheet called "How
To Find a Doctor or Treatment Facility If You Have Cancer."
Men with prostate cancer have many treatment options. The treatment that is
best for one man may not be best for another.
Treatment may involve
surgery,
radiation therapy, or
hormone therapy. You may have a
combination of treatments. If your doctor recommends
watchful waiting, your health will be
monitored closely. You will have treatment only if symptoms occur or get worse.
Cancer treatment is either
local therapy or
systemic therapy:
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Local therapy: Surgery and radiation therapy are local treatments. They
remove or destroy cancer in the prostate. When prostate cancer has spread to
other parts of the body, local therapy may be used to control the disease in
those specific areas.
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Systemic therapy: Hormone therapy is systemic therapy. Hormones are
given to control cancer that has spread.
The treatment that is right for you depends on the stage of the cancer, the
grade of the tumor, your symptoms, and your general health. Your doctor will
describe your treatment choices and the expected results.
Because cancer treatments often damage healthy cells and tissues,
side effects are common. Side effects
depend mainly on the type and extent of the treatment. Side effects may not be
the same for each man, and they may change from one treatment session to the
next. NCI's booklet
Know Your Options: Understanding Treatment Choices for Prostate Cancer
can tell you more about treatments and their side effects.
You should consider both the expected benefits and possible side effects of
each treatment option. You may want to discuss with your doctor the possible
effects on sexual activity. You can work with your doctor to create a treatment
plan that reflects your medical needs and personal values.
At any stage of disease,
supportive care is available to control
pain and other symptoms, to relieve the side effects of treatment, and to ease
emotional concerns. Information about such care is available on NCI's Web site
at http://www.cancer.gov/cancertopics/coping
and from Information Specialists at 1-800-4-CANCER or
LiveHelp.
You may want to talk to your doctor about taking part in a
clinical trial, a research study of new
treatment methods. The section on "The
Promise of Cancer Research" has more information about clinical trials.
You may want to ask your doctor these questions before your treatment begins:
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What is the stage of the disease? Do any lymph nodes show signs of cancer? Has
the cancer spread?
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What is the grade of the tumor?
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What is the goal of treatment? What are my treatment choices? Which do you
recommend for me? Why?
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What are the expected benefits of each kind of treatment?
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What are the risks and possible side effects of each treatment? How can side
effects be managed?
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What can I do to prepare for treatment?
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Will I need to stay in the hospital? If so, for how long?
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How will treatment affect my normal activities? Will it affect my sex life?
Will I have urinary problems? Will I have bowel problems?
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What will the treatment cost? Will my insurance cover it?
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Would a clinical trial (research study) be appropriate for me?
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Surgery is a common treatment for early stage prostate cancer. Your doctor may
remove the whole prostate or only part of it. In some cases, your doctor can
use a method known as
nerve-sparing surgery. This type of
surgery may save the
nerves that control erection. But if you
have a large tumor or a tumor that is very close to the nerves, you may not be
able to have this surgery.
Each type of surgery has benefits and risks. Your doctor can further describe
these types:
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Radical retropubic prostatectomy: The
doctor removes the entire prostate and nearby lymph nodes through an
incision (cut) in the abdomen.
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Radical perineal prostatectomy: The
doctor removes the entire prostate through a cut between the
scrotum and the
anus. Nearby lymph nodes may be removed
through a separate cut in the abdomen.
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Laparoscopic prostatectomy: The
doctor removes the entire prostate and nearby lymph nodes through small
incisions, rather than a single long cut in the abdomen. A thin, lighted tube
(a
laparoscope) is used to help remove the
prostate.
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Transurethral resection of the prostate (TURP):
The doctor removes part of the prostate with a long, thin device that is
inserted through the urethra. The cancer is cut from the prostate. TURP may not
remove all of the cancer. But it can remove tissue that blocks the flow of
urine.
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Cryosurgery: This type of surgery
for prostate cancer is under study at some medical centers. (More about
cryosurgery is in "The Promise of
Cancer Research" section.)
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Pelvic lymphadenectomy: This is
routinely done during prostatectomy. The doctor removes lymph nodes in the
pelvis to see if cancer has spread to them. If there are cancer cells in the
lymph nodes, the disease may have spread to other parts of the body. In this
case, the doctor may suggest other types of treatment.
The time it takes to heal after surgery is different for each man and depends
on the type of surgery he has had. You may be uncomfortable for the first few
days. However, medicine can help control the pain. Before surgery, you should
discuss the plan for pain relief with your doctor or nurse. After surgery, your
doctor can adjust the plan if you need more pain relief.
After surgery, the urethra needs time to heal. You will have a
catheter. A catheter is a tube put through
the urethra into the bladder to drain urine. You will have the catheter for 5
days to 3 weeks. Your nurse or doctor will show you how to care for it.
Surgery may cause short-term problems, such as
incontinence. After surgery, some men may
lose control of the flow of urine (urinary
incontinence). Most men regain bladder control after a few
weeks.
Some men may become
impotent. Nerve-sparing surgery is an
attempt to avoid the problem of impotence. If a man can have nerve-sparing
surgery and the operation is a success, impotence may not last. In some cases,
men become permanently impotent. You can talk with your doctor about medicine
and other ways to help manage the sexual effects of cancer treatment.
If your prostate is removed, you will no longer produce semen. You will have
dry orgasms. If you wish to father
children, you may consider
sperm banking or a
sperm retrieval procedure.
You may want to ask your doctor these questions before choosing surgery:
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What kinds of surgery can I consider? Is nerve-sparing surgery an option for
me? Which operation do you recommend for me? Why?
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How will I feel after the operation?
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If I have pain, how can we control it?
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Will I have any lasting side effects?
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Is there someone I can talk with who has had the same surgery I'll be having?
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Radiation therapy (also called radiotherapy) uses high-energy rays to kill
cancer cells. It affects cells only in the treated area.
For early stage prostate cancer, radiation treatment may be used instead of
surgery. It also may be used after surgery to destroy any cancer cells that
remain in the area. In later stages of prostate cancer, radiation treatment may
be used to help relieve pain.
Doctors use two types of radiation therapy to treat prostate cancer. Some men
receive both types:
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External radiation: The radiation
comes from a large machine outside the body. Men go to a hospital or clinic for
treatment. Treatments are usually 5 days a week for several weeks. Many men
receive
3-dimensional conformal radiation therapy.
This type of treatment more closely targets the cancer. It spares healthy
tissue.
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Internal radiation (implant
radiation therapy or
brachytherapy): The radiation
comes from radioactive material usually contained in small seeds. The seeds are
put into the tissue. They give off radiation for months. The seeds are harmless
and do not need to be removed.
Side effects depend mainly on the dose and type of radiation. You are likely to
be very tired during radiation therapy, especially in the later weeks of
treatment. Resting is important, but doctors usually advise patients to try to
stay as active as they can.
If you have external radiation, you may have diarrhea or frequent and
uncomfortable urination. Some men have lasting bowel or urinary problems. Your
skin in the treated area may become red, dry, and tender. You may lose hair in
the treated area. The hair may not grow back.
Internal radiation treatment may cause incontinence. This side effect usually
goes away. Lasting side effects from internal radiation are not common.
Both internal and external radiation can cause impotence. Internal radiation is
less likely to have this effect.
You may want to ask your doctor these questions before choosing radiation
therapy:
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How will radiation be given?
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When will treatment start? When will it end? How often will I have treatments?
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What can I do to take care of myself before, during, and after treatment?
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How will I feel during treatment? Will I be able to drive myself to and from
treatment?
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How will we know the treatment is working?
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How will I feel after the radiation?
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Are there any lasting effects?
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What is the chance that the cancer will come back in my prostate?
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How often will I need checkups?
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Hormone therapy keeps prostate cancer cells from getting the male hormones
(androgens) they need to grow. The testicles are the body's main source of the
male hormone testosterone. The adrenal gland makes a
small amount of testosterone.
Hormone treatment uses drugs or surgery:
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Drugs: Your doctor may suggest a drug that can block natural hormones.
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Surgery: Surgery to remove the testicles is called
orchiectomy.
After orchiectomy or treatment with an LH-RH agonist, your body no longer gets
testosterone from the testicles. However, the adrenal gland still produces a small amount
of male hormones. You may receive an antiandrogen to block the action of the
male hormones that remain. This combination of treatments is known as total
androgen blockade. Studies have not shown whether
total androgen blockade is more effective
than surgery or an LH-RH agonist alone.
Doctors can usually control prostate cancer that has spread to other parts of
the body with hormone therapy. The cancer often does not grow for several
years. But in time, most prostate cancers can grow with very little or no male
hormones. Hormone therapy is no longer helpful. At that time, your doctor may
suggest other forms of treatment that are under study.
Hormone therapy is likely to affect your
quality of life. It often causes side
effects such as impotence, hot flashes, loss of sexual desire, and weaker
bones. An LH-RH agonist may make your symptoms worse for a short time when you
first take it. This temporary problem is called "flare." The treatment
gradually causes your testosterone level to fall. Without testosterone, tumor
growth slows. Your condition may improve. (To prevent flare, your doctor may
give you an antiandrogen for a while along with the LH-RH agonist.)
Antiandrogens (such as nilutamide) can cause nausea, diarrhea, or breast growth
or tenderness. Rarely, they may cause liver problems (pain in the abdomen,
yellow eyes, or dark urine). Some men who use nilutamide may have difficulty
breathing. Some may have trouble adjusting to sudden changes in light.
If used for a long time, ketoconazole may cause liver problems, and
aminoglutethimide can cause skin rashes. If you receive total androgen
blockade, you may have more side effects than if you have just one type of
hormone treatment.
Any treatment that lowers hormone levels can weaken your bones. Your doctor can
suggest medicines or
dietary supplements that can reduce your
risk of bone fractures.
You may want to ask your doctor these questions before choosing hormone
therapy:
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What kind of hormone therapy will I have? Would you recommend drugs or surgery?
Why?
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When will treatment start? How often will I have treatments? When will it end?
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Where will I go for treatment? Will I be able to drive home afterward?
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If I have surgery, how long will I need to stay in the hospital?
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How will I feel during treatment?
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What can I do to take care of myself during treatment?
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How will we know the treatment is working?
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Which side effects should I tell you about?
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Will there be lasting side effects?
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You may choose watchful waiting if the risks and possible side effects of
treatment outweigh the possible benefits. Your doctor may offer this choice if
you are older or have other serious health problems. Your doctor may also
suggest watchful waiting if you are diagnosed with early stage prostate cancer
that seems to be slowly growing. Your doctor will offer you treatment if
symptoms occur or get worse.
Watchful waiting avoids or delays the side effects of surgery and radiation,
but this choice has risks. It may reduce the chance to control cancer before it
spreads. Also, it may be harder to cope with surgery and radiation therapy as
you age.
You may decide against watchful waiting if you do not want to live with an
untreated cancer. If you choose watchful waiting but grow concerned later, you
should discuss your feelings with your doctor. A different approach is nearly
always available.
Watchful waiting is under study. See "The
Promise of Cancer Research" for information about this study.
You may want to ask your doctor these questions before choosing watchful
waiting:
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If I choose watchful waiting, can I change my mind later on?
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Will the cancer be harder to treat later?
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How often will I have checkups?
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Between checkups, what problems should I report?
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