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Choosing the best treatment for prostate cancer can be a difficult task for many men and their families. Indeed, many physicians remain divided over this very issue. This information can help you discuss treatment options with your physician, as well as help you and your doctor determine the best and most appropriate choice for you.

Watchful Waiting
No one can predict how long it will take cancer to spread, or how long someone has to live. Untreated, prostate cancer inevitably grows. However, it may do so slowly. The growth of the cancer may be slow enough that it causes no problems during a particular man’s lifetime, even when left untreated. Therefore, watchful waiting is a reasonable and possible option for some men with prostate cancer.

Age, family history and other health-related problems are all-important factors to consider when selecting this option. Elderly men most often find the watchful waiting option ideal, particularly when the cancer is small and a low grade. However, studies show that prostate cancer may be a significant threat to life or health within 10 years if the cancer is of a higher grade or stage.

Surgical Treatment for Prostate Cancer
For more than three decades, the "gold standard" treatment for prostate cancer has been radical prostatectomy, or removal of the prostate gland. This option is used only if the cancer has not obviously spread beyond the gland. Removal of the prostate gland requires a two to five day hospital stay and a recovery period of several weeks. This surgery’s common side effects include loss of erectile ability (impotence) and urinary leakage (incontinence).

Refinements to radical prostatectomy include “nerve sparing” and “bladder neck sparing” surgeries, which may be performed in qualified patients. In these operations, the prostate is surgically removed, but the physician preserves the nerves necessary for erections and/or the bladder neck, which is the outlet of the bladder. For the patient, these important advances allow earlier return of continence after surgery and possible preservation of erectile function. Typically hospitalization for this procedure is two to three days, with a home recover period of three to four weeks before resuming normal activities.

Because a tumor frequently spreads to tissues adjacent to the prostate, removal of the prostate does not guarantee a cure. Even the best reported surgical results show cure in only about three our of every four prostatectomy patients. The presence of Prostate Specific Antigens (PSA) after surgery may indicate prostatectomy failure and the need for additional therapy, such as external beam radiation.

External Beam Radiation
External beam radiation therapy kills cancer cells by decreasing their ability to grow and divide. Many consider radiation a form of “micro-surgery” because it has the ability to eradicate tumor cells while preserving normal cells and tissues. Radiation usually involves seven to eight weeks of daily treatments in which beams of radiation are directed at the prostate gland in order to destroy the cancer cells.

The procedure itself is painless. However, side effects such as rectal irritation, diarrhea, frequent urination and fatigue may result from external beam radiation. Impotence is less likely from radiation than from surgery.

Seed Implant Therapy (Prostate Brachytherapy)
Ultrasound-guided prostate seed implant (prostate brachytherapy), a procedure that Northwest Hospital physicians pioneered in the United States, is one of the best treatment options for early stage prostate cancer. The procedure involves precise placement of small, radioactive seeds into the prostate using ultrasound guidance without open surgery. By doing so, only the prostate itself is radiated, limiting the radiation dose to nearby normal, health tissue. The radioactive seeds implanted into the prostate gradually lose radioactivity over time, destroying cancer cells, but sparing normal cells. With this procedure, there is a minimal risk of impotence and incontinence.

Prostate brachytherapy is a minimally-invasive procedure that takes approximately 45 minutes in an Outpatient Surgery Center. With seeding, patients go home the same day and are usually back to their usual daily activities within a day or two.

In 1998, and again in 2000, Northwest Hospital physicians published the first study results to report actual ten and 12-year results. These studies showed that when followed for many years after treatment for their early-stage prostate cancer, 66 to 69 percent of patients who received brachytherapy were disease-free and had PSA levels comparable to non-cancer patients. Compared to radical prostatectomy results reported by any major cancer centers across the United States, our results with brachytherapy were either the same or significantly better than those of surgery. The results were also consistently much better than those of patients who underwent only external beam radiation.

Combination Therapy
External beam radiation is frequently used in combination with seeding. In this situation, men who are at increased risk of cancer outside their prostates (and hence are usually considered incurable with a radical prostatectomy) receive treatment with both brachytherapy and an abbreviated course of external beam therapy. Men at risk for cancer outside their prostate may have a high PSA, advance clinical stage, and/or high Gleason score. (A Gleason score is a method of classifying prostate cancer cells on a scale of 2 to 10. The higher the Gleason score the faster the cancer is likely to grow and the more likely it is to spread beyond the prostate.) Results from seeding plus external beam radiation in this group of “high risk” men are excellent with up to 79 percent disease-free survival observed in patients followed up for 12 years.

Hormone Therapy
Several different types of hormone therapy may be used to treat prostate cancer. The goal is to reduce or stop production of male hormones that feed both the normal prostate and the cancer. In this manner, the prostate may be made to shrink, which is occasionally necessary for an optimum seed implant. This therapy is usually administered as a monthly injection. Hormone therapy is sometimes used to make tumors more responsive to radiation.

Nutritional and Lifestyle Therapy
It has been well established that dietary factors can have a large impact on a man’s chance of developing prostate cancer. Likewise, nutrition and lifestyle are important in fully combating the disease and the potential side effects of treatment. The complex nutritional interactions with compounds like isoflavones, selenium, lycopenes, chromium, co-enzyme Q-10, and many more are important to regulate before, during, and after therapy.