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Treating prostate cancer

If your prostate biopsy shows that you have prostate cancer, there are several treatment options. Your urologist will discuss the treatment options with you. Most men will also be offered an appointment to discuss the treatment options with a radiation oncologist.

Active surveillance

Active surveillance is an option if doctors consider your cancer to be low risk.

Active surveillance means that you'll have repeat tests at regular intervals. The tests are likely to include PSA tests, digital rectal examinations and biopsies.

Most men will have an MRI scan within six months of their diagnosis to confirm that it's safe for them to stay on active surveillance

If the tests show that your cancer is getting worse, your doctor may recommend surgery or radiation therapy. But many men with prostate cancer never need treatment.

Surgery (radical prostatectomy)

Radical prostatectomy (pross-ta-tek-tom-ee) is an attempt to cure your cancer.

In a radical prostatectomy operation, the surgeon removes your prostate. They then re-join your bladder back to your urethra (the tube that carries urine from your bladder). They also place a catheter in your bladder to drain the urine.

After the operation, you'll stay in hospital for two to three days. The catheter will stay in for two weeks and you'll manage it at home with a drainage bag. See Urinary catheters for information about managing your catheter.

After two weeks, a continence nurse specialist will remove your catheter. They'll also teach you pelvic floor exercises to help you regain your bladder control. Most men need to wear pads initially to control leakage. They normally don't need the pads after three to six months, as the pelvic floor exercises strengthen their muscles.

The surgery can cause impotence, or inability to have an erection. This occurs in 50 to 70% of men. But this doesn't mean that you can't continue to have a sex life. Medicines such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), and mechanical aids may help you if you're impotent because of surgery.

Robotic surgery

Surgeons can also do a radical prostatectomy operation using keyhole surgery. This is called robot-assisted laparoscopic radical prostatectomy. It's called this because the surgeon uses robotic instruments to do the operation. You should recover faster after keyhole surgery.

Robot-assisted laparoscopic radical prostatectomy is only done privately, which means you have to pay for it.

Radiation therapy

Radiation therapy is an attempt to cure your cancer.

Radiation therapy kills the cancer cells within your prostate. The success rates for radiation therapy and surgery are similar.

You need to have the radiation therapy daily (for about 15 minutes) for seven to eight weeks. You can usually keep working while having the treatment and carry on with your normal activities.

After radiation therapy, around 30 to 40% of men suffer from impotence. Around 10% of men have a permanent change in bowel habits and a similar number have problems with urinary incontinence.

Brachytherapy

In some cases, radioactive seeds can be used to apply the radiation. This is called brachytherapy (brak-i-therapy). Surgeons implant the seeds into your prostate under a general anaesthetic. Brachytherapy generally has less side effects than conventional radiation therapy.

Brachytherapy is only done privately, which means you have to pay for it.

Watch and wait

Watch and wait is an option if you only have a small amount of cancer, and it appears to be slow growing.

It's also used if your age or medical condition makes it unlikely that the cancer will cause you any problems within your expected lifetime.

Watch and wait usually involves fewer tests than active surveillance. You'll usually have check-ups from your GP rather than at the hospital. You're unlikely to have further prostate biopsies.

At some point, your doctor might recommend hormone treatment. You're unlikely to have surgery or radiation to cure the cancer.

Hormonal treatment

Hormonal treatment aims to control your cancer rather than cure it.

Male hormones help prostate cancer grow. Reducing the male hormones in your body, takes away the stimulus for growth.

The traditional form of hormonal treatment is to remove your testes. This procedure is called an orchidectomy (or-kid-ec-tom-ee). This takes away the source of your male hormones, which your testes produce.

Side effects of this are similar to menopause in women. You can have hot flushes and put on a bit of weight. You might also have some thinning of your bones.

Another side effect of this treatment is losing your sexual desire and ability to have an erection.

An advantage of an orchidectomy is that it doesn't need ongoing treatment.

Another form of hormonal treatment is by injections every three to six months. The injections have similar side effects to the orchidectomy operation.

There are also two tablet forms of hormonal treatment. These block your male hormones from acting on your prostate. You have a 25% chance of keeping your sexual desire and erections with this treatment.

The downside is that you need to take three to six tablets per day. They can cause intestinal tract upset and diarrhoea. The tablets can also upset your liver.

Uses information written by Urology Associates, Canterbury Urology Research Trust and Canterbury DHB. Adapted by HealthInfo clinical advisers. Endorsed by Urology Department, Canterbury DHB. Page created August 2018.

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