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The Pros and Cons of Prostate Cancer Treatment Options

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The standard treatment options for prostate cancer are active surveillance, radical prostatectomy, external beam radiation therapy, and brachytherapy. Here’s a look at the advantages and disadvantages of each, in brief. 

Active surveillance for prostate cancer 

Advantages

• Avoids side effects from radiation therapy or radical prostatectomy

• No hospitalization or surgical risks 

Disadvantages

• Requires close monitoring (regular digital rectal exams, PSA tests, and prostate biopsy) to monitor for signs of progression

• May be psychologically stressful knowing that the prostate cancer will not be actively treated until it progresses 

Radical prostatectomy for prostate cancer 

Advantages

• Proven to reduce prostate cancer death rates

• Removed tissue allows accurate staging

• PSA levels reliably predict recurrence

• Fewer bowel/rectal problems than with EBRT

• Less urinary urgency and frequency than with EBRT or brachytherapy 

Disadvantages

• General risks of surgery

• Hospitalization required

• Catheter in place for 1-2 weeks

• Recovery period: at least 1 month

• Incontinence: 5-20% (mostly stress incontinence)

• Erectile dysfunction: 30-50% at 5 years (with nerve preservation) 

External beam radiation therapy (EBRT) for prostate cancer 

Advantages

• No hospitalization or surgical risks

• Activities unrestricted

• Low risk of urinary incontinence (1-2%)

• Less urinary retention than with brachytherapy 

Disadvantages

• No post-treatment staging information

• Daily treatments for 6-8 weeks

• Fatigue may occur when treatment ends

• Erectile dysfunction: 30-50% at 5 years

• Bowel/rectal problems: 5-10% (urgency, pain, diarrhea, or bleeding) but typically improve after treatment

• Bladder irritation: 5% (urinary frequency, urgency, discomfort) 

Brachytherapy for prostate cancer 

Advantages

• No hospitalization or surgical risks

• Less radiation damage to healthy tissue

• One treatment

• Low risk of urinary incontinence (1-2%) 

Disadvantages

No post-treatment staging information

• Less favorable option for men with intermediate- or high-risk prostate cancer

• Urinary retention, urgency, and frequency more common than with other treatments, especially in men with lower urinary tract symptoms before treatment 

Posted in Prostate Disorders on March 24, 2011


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