What are the risks and benefits of radical prostatectomy?
If you're young and in good health, the short-term risks of this surgery are low. The hospital stay is usually 2 to 3 days, with the catheter left in place for 2 to 3 weeks. You're usually able to go back to work in about 1 month. You shouldn't have severe pain with this surgery. Most men regain bladder control a few weeks to several months after the surgery.
The main advantage of surgery is that it offers the most certain treatment. That is, if all of the cancer is removed during surgery, you are probably cured. Also, the surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor.
Surgery does have risks. The main risks of radical prostatectomy are incontinence (loss of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Most bladder and impotence problems improve with time.
Fortunately, only a very low percentage of men have severe incontinence after radical prostatectomy. Up to 35% of men have some accidental leakage of urine during heavy lifting, coughing, or laughing. The chance of impotence (erectile dysfunction) is lower if the surgeon is able to avoid cutting the nerves. This may not be possible if the tumor is large. Your age and degree of sexual function before the surgery are also important factors. If you're younger than 50 years of age when you have this surgery, you're likely to regain sexual function. If you're older than 70 years of age, you're more likely to lose sexual function. Remember, even if the nerves are cut, feeling in your penis and orgasms remain normal. Only the ability to get an erection for sexual intercourse is lost. However, there are medicines and devices that can help get an erection. You could lose a lot of blood during this surgery. Before the surgery, you might want to save about 2 units of your own blood in case you need a transfusion.
What are the risks and benefits of radiation therapy?
Older studies show that about one-half of patients become impotent within 5 years of having radiation therapy, but newer forms of radiation may have different outcomes. Many men feel very tired at the end of the treatment period. About 15% to 30% of men who have radiation therapy have side effects like urinary burning, urinary bleeding, frequent urination, rectal bleeding, rectal discomfort, or diarrhea during or shortly after the treatment. Erectile dysfunction (impotence) is a common side effect and often gets worse over time. More serious complications are rare. However, a degree of uncertainty goes along with radiation treatment. Since the prostate gland and the lymph nodes are not taken out, your doctor can't tell the exact size of the tumor. The cancer could come back many years after radiation treatment.
At 10 years after treatment, cure rates are about the same for radiation therapy and radical prostatectomy. Men who have radiation therapy avoid the risks of surgery. There is also no risk of bleeding. You don't have to stay in the hospital and you'll recover faster. Daily activities can usually go on during the treatment. Incontinence is extremely rare after radiation therapy. Surgery, however, may give you a better chance of cure over the long term.
What are the risks and benefits of hormone therapy?
Hormone therapy often is used in combination with other treatments. It does have side effects. Some of the more serious side effects include loss of sex drive, weakened bones, erectile dysfunction, fatigue, and osteoporosis.
Hormone treatments may be used in patients who have cancer that has spread beyond the prostate gland. While prostate cancer that has spread usually responds to 1 or 2 years of hormone therapy, it does not cure the disease and most tumors eventually begin to grow again. Once this happens, the treatment goal is to control symptoms. No current treatment can cure prostate cancer once hormone therapy stops working. Recently however, chemotherapy has been shown to help some people who have advanced prostate cancer live longer.
Treatment Options for Prostate Cancer: Evaluating the Evidence by V Bhatnagar, RM Kaplan (American Family Physician May 15, 2005, http://www.aafp.org/afp/20050515/1915.html)
Written by familydoctor.org editorial staff