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Prostate Cancer Treatment Pros & Cons

Active Surveillance / Watchful Waiting

Non-Treatment; Continued monitoring of Prostate Cancer through PSA blood tests, DREs, and ultrasound scans. Biopsies may be done as well to assess the aggressiveness of the prostate cancer.

Recommended For:

  • PSA below 10
  • Gleason Score below 7
  • No symptoms
  • Prostate Cancer that is expected to grow slowly (based on Gleason score)
  • Small, contained cancer within the prostate
  • Those with life expectancy less than 10 years, older in age, or have other serious health problems

Pros To Active Surveillance / Watchful Waiting

  • No surgery
  • No hospitalization
  • No direct side-effects
  • Modern Technology and New Imaging allow for more accurate monitoring

Cons To Active Surveillance / Watchful Waiting

  • Less proactive, wait-and-see approach
  • Requires frequent follow-ups with doctors which may include PSA blood test and Digital Rectal Exams (DRE) every 3 to
  • Can create psychological stress
  • 6 months and trans rectal ultrasound-guided prostate biopsies once a year
  • Allows cancer to get worse and spread which may result in limiting treatment options and ultimately affect the chances of curing the cancer
  • May lead to further treatment if prostate cancer begins to grow or get worse

Biologic Therapy / Immunotherapy

Biological substances made in a lab or by the body are used to boost the immune system to enhance the body’s ability to repair itself and prevent the growth and spread of prostate cancer cells. Provenge is the first FDA approved Immunotherapy treatment and vaccine.

Recommended For:

  • Men with advanced, metastatic hormone resistant prostate cancer without any symptoms
  • Men who have not had success with other treatments
  • Men who have had hormonal therapy
  • Men with elevated PSA levels

Pros To Biologic Therapy / Immunotherapy

  • Minimally invasive procedure
  • Boosts immune system
  • Helps to identify prostate cancer cells
  • Can help change how prostate cancer cells behave
  • Can help change how prostate cancer cells behave
  • Can be performed in a hospital or at home
  • Reduced toxicity

Cons To Biologic Therapy / Immunotherapy

  • Fatigue
  • Nausea
  • Dizziness
  • Appetite suppression
  • Allergic reactions may develop
  • Some cannot continue treatment

Brachytherapy (Internal Radiation Therapy)

Also known as implantation or interstitial radiation therapy, where small radioactive pellets (or “seeds”) the size of a grain of rice are placed directly into the prostate. Permanent Brachytherapy (low dose rate) inserts radioactive (iodine-125 or palladium-103) pellets directly into the prostate with the use of a needle by going through the skin in the area between the anus and the scrotum. These low doses of radiation are release for weeks or months depending on the case. Typically, 40 to 100 of these radioactive seeds are placed and left in the prostate until the radioactive material has been completely dissolved. Temporary Brachytherapy (high dose rate) delivers radioactive iridium-192 or cesium-137 through catheters and are kept in place for 5 to 15 minutes. The radioactive pellets are removed after each treatment and the catheters are removed after the final treatment.

Recommended For:

  • Men with lower Gleason scores
  • Men with prostate cancer in the earlier stages
  • Men with relatively slow-growing prostate cancer
  • Men healthy enough for surgery

Pros To Brachytherapy (Internal Radiation Therapy)

  • One-time procedure
  • Minimally invasive
  • No surgical risks
  • No hospital stays
  • Most of the radiation is concentrated in the prostate
  • Little to no damage to the tissue around the prostate (nerves, bladder, rectum)

Cons To Brachytherapy (Internal Radiation Therapy)

  • May be forced to stay away from children and pregnant women due to the internal radiation
  • May be forced to strain urine in case of pellets moving
  • Can cause bowel, urinary, and erectile issues
  • No staging information after treatment

Chemotherapy

Anti-cancer drugs are taken orally or injected into a vein and enter the bloodstream then spread throughout the body to stop the growth of prostate cancer cells by killing them or restricting their division to other parts of the body.

Recommended For:

  • Men with prostate cancer that has spread outside of the prostate gland and through the body
  • Men for whom hormone therapy is not working

Pros To Chemotherapy

  • Can slow down the growth of the prostate cancer
  • Can reduce symptoms

Cons To Chemotherapy

  • Hair loss
  • Mouth sores
  • Diarrhea
  • No staging information after treatment
  • Nausea and vomiting
  • Loss of appetite
  • Increased odds of infections
  • Fatigue
  • Easy bruising/bleeding

Cryosurgery (Cryotherapy)

Also known as cryoablation, transrectal ultrasound (TRUS) is used to guide multiple needles directly into the prostate through the skin between the anus and scrotum. Extremely cold gases are then sent through the needles, which then create ice balls that freeze and destroy the prostate. Warming catheter is inserted into the urethra to protect it from the freezing temperatures. Spinal, epidural, or general anesthesia is required.