Medical Information
What is localized prostate cancer?
Prostate
cancer is the abnormal growth of cells in the tissues of the
prostate gland 
. Localized prostate cancer is cancer than has not spread beyond
the prostate gland.
Prostate cancer is the most common cancer in
men. Most men who get it are older than 65. If your father, brother, or son has
had prostate cancer, you have a higher-than-average risk for developing the
disease.1
Unlike many other cancers,
prostate cancer is usually slow-growing. Most men will die with prostate cancer but not of
prostate cancer.2
African-American men
have higher rates of both prostate cancer and deaths caused by prostate
cancer.1
Early prostate cancer usually
does not cause symptoms. When prostate cancer is diagnosed early, before it has
spread outside the prostate gland, it may be cured with radiation or surgery to
remove the prostate. As prostate cancer grows or spreads, symptoms may develop,
including urinary problems (such as blood in the urine) and bone pain.
Prostate cancer that has grown through the prostate is called advanced
prostate cancer, and treatment choices are different for that
stage of cancer. For more information, see the topic
Prostate Cancer, Advanced or Metastatic.
What are the treatment choices for localized prostate cancer?
Localized prostate cancer may be treated with radiation
therapy or surgery. You may also choose to watch and wait.
- Watchful waiting, also called
surveillance or observation, means you are being monitored closely by your
doctor, but you are not receiving active treatment such as surgery or radiation
therapy as long as symptoms do not occur or get worse.
- Radical prostatectomy is an operation to remove the
entire prostate as well as any nearby tissue that may contain cancer. It may be
done as open surgery, by making a large incision, or as laparoscopic surgery,
by making several very small incisions in the belly and using a tiny camera and
special instruments to remove the prostate. Sometimes
lymph nodes in the area also are removed so they can be checked for signs of
cancer.
- Radiation therapy uses X-rays and other types of
radiation to kill the cancer cells. This may be done with:
- External-beam radiation, in which a
machine aims high-energy rays at the cancer.
- Brachytherapy, in
which tiny pellets of radioactive material are injected directly into or near
the cancer.
- A combination of external radiation and
brachytherapy.
If you are young and in good health or if your prostate
cancer is fast-growing (higher-grade), your doctor probably will
recommend surgery and/or radiation therapy to remove or destroy the cancer.
Even though prostate cancer is usually slow-growing, it may eventually spread
and cause symptoms and may threaten your life.3
Age is not a reason to not have surgery or other treatment. But if you
are around 70 or older, it is important to consider other medical conditions
you may have, such as
heart disease, as you make your treatment decisions.
When is prostatectomy used to treat prostate cancer?
Radical prostatectomy is most often recommended when a man is in good
general health and has a life expectancy of at least another 10 years. In
addition, there should be an expectation that the cancer can be entirely
removed. If testing suggests that the cancer may have spread outside the
prostate, or if you have other health problems that may add to the risks of
major surgery, prostatectomy usually is not recommended.
Radical
prostatectomy generally is effective in treating cancer that has not spread
beyond the prostate gland. In follow-up
PSA tests done in the years after prostatectomy, most
men show no evidence of cancer.3
Laparoscopic radical prostatectomy sometimes is used
instead of open prostatectomy, which requires a larger cut in the belly.
Some specially trained surgeons in large medical centers do
robotic-assisted laparoscopic radical prostatectomy. The surgeon controls the
arms that hold the surgery tools and laparoscope. There are reports that it
helps the surgeon see very well and work with less error.
When is radiation therapy used to treat prostate cancer?
Radiation therapy is most effective in treating cancers that have not
spread outside the prostate. It may be used alone or combined with hormonal
treatment. In rare cases, it is used with surgery. Radiation therapy works as
well as surgery for the treatment of early-stage localized prostate
cancer.4 But for radiation therapy used alone in young
men, there are concerns about cancer recurrence.
What are the risks of prostatectomy?
A radical
prostatectomy is a surgical procedure and carries all the risks of any major
surgery, including
heart attack,
pulmonary embolism, bleeding, infection, and reactions
to
anesthesia or medicines.
Also,
prostatectomy may cause bladder problems and erection problems. Increasingly,
this surgery is done in a way that helps preserve the nerves that control
erections. Most men who have nerve-sparing prostatectomies will regain the
ability to have an erection within 4 to 6 months after surgery.3 It takes some men up to 2 years to regain full
function.
More than 30% of men who have a radical prostatectomy
develop
bladder problems, ranging from a need to wear pads to
occasional dribbling during stressful activities. Between 2% and 5% still have
severe problems 6 months after having a prostatectomy. After 1 year, 92% no
longer have problems.5, 6, 3
Other possible
complications include scar tissue that may narrow the outlet to your bladder
and injury to the rectum or the
ureters.
Evidence shows that the side
effects of prostate surgery are reduced when the prostatectomy is done by a
surgeon who is very experienced in this particular operation.7
What are the risks of radiation therapy?
About
half of men who have external radiation develop erection problems within 5
years of treatment.3 Erection problems following
radiation therapy increase over time.8
Most other side effects generally go away when treatment is finished. But
in some cases they may become chronic. Other side effects include:4
- An irritated rectum and an urgent need to
pass a stool. This is called proctitis.
- An inflamed bladder and
urination problems. This is called cystitis.
- An inflamed intestine
and diarrhea. This is called enteritis.
- Being unable to have an
erection. This is called impotence.
- Being unable to control
urination. This is called incontinence.
- Painful urination. This is
called dysuria.
Follow-up treatment
Any type of treatment for
prostate cancer will need to be followed by regular checkups. Your follow-up
care probably will include physical exams, prostate-specific antigen (PSA)
tests to monitor PSA levels and measure the speed of any changes,
digital rectal exams, and
biopsies as needed to examine suspicious
tissue.
For more information, see the topic
Prostate Cancer.
