Your urologist will advise you on the best treatment after considering your age, general health, how fast the prostate cancer is growing (the grade) and whether it has spread (the stage). Considering the side effects that you are prepared to accept is also important.
Some people may choose not to receive any treatment and undergo regular check-ups instead. The side effects from treating prostate cancer may make you feel worse than the illness itself. You should discuss with your doctor the best option for your individual case.
The treatments for localised prostate cancer include surgery and radiotherapy. If the cancer has spread beyond the prostate, hormone therapy may be used. Sometimes chemotherapy is also used. You may have one of these treatments or a combination.
Research into the best way to treat prostate cancer is ongoing.
It is possible that you will talk with other people in the hospital undergoing a treatment different to yours. This is due to different circumstances or the recommendations of different doctors. If you have questions regarding your treatment, talk with your doctor or a nurse. You may want to make a list of questions and invite a relative or a friend to go with you.
Some people prefer to get a second opinion to help them decide which treatment to take. Most doctors are willing to recommend another specialist to you.
Your doctor will discuss with you which surgery is the best for you based on the type of cancer, the size of the cancer cells and whether or not the cancer has spread to other areas.
In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles (which make most of the content in semen).
It can be undertaken as open or keyhole surgery with the help of a robot to remove the prostate gland. This procedure can be performed when the cancer cells have not yet spread. Usually, it is done under general anaesthetic, with the surgery taking about four hours.
This surgery can cause problems with achieving an erection and urinary incontinence. Given these and other potential side effects, it is important to learn more about the possible risks before undergoing surgery. Your doctor will discuss with you the surgery and other possible treatments.
After the surgery
After the prostate gland has been removed, you will receive an intravenous injection and have a thin tube (catheter) inserted into your bladder through which urine can be discharged. The catheter should only be removed by a medical professional. The areas around your lower abdomen and pelvis may feel painful in the first few days after surgery, especially when you walk, and you can consider taking pain-killers. If the dose is not sufficient, inform the medical professionals treating you.
You should be able to go home three or four days after the surgery. If you undergo laparoscopic surgery, it may be earlier. You may need to have the catheter for 1 to 2 weeks after you leave hospital.
An alternative to open surgery for some men is to remove the prostate through keyhole surgery. This is called a laparoscopic prostatectomy. Five or six small cuts are made in the navel and the lower abdomen area. A small telescope with a camera attached and other medical instruments are passed through the holes to allow the surgeon to see inside the abdomen.
The doctor may need the help of a robotic arm during the surgery to enhance accuracy. Compared with open surgery, keyhole surgery leaves a smaller scar, enables faster healing, means there is less chance of infection and requires a shorter hospital stay.
Transurethral Resection (TURP)
If the prostate cannot be removed due to the extent of the cancer, symptoms such as the need to urinate often can be relieved by removing blockages in the urinary tract. This operation is called a transurethral resection of the prostate (TURP). It is often used for those with late-stage prostate cancer or those for whom the removal of the entire prostate gland is not an option.
It is usually done under general anesthetic or a spinal anesthetic.
A telescope-like instrument is passed through the opening in the penis and up the urethra to remove the blockage.
Always talk through the details of any surgery and raise any questions or concerns with your doctor. Your consent is required before any surgery or medical procedure can be performed.
After the surgery
After the surgery, the medical staff caring for you will encourage you to move about within 24 hours of the surgery. After a transurethral resection, you may need to take fluids intravenously until you are able to drink by yourself. A catheter will be inserted into your bladder for the removal of urine.
You should be able to return home three or four days after surgery. Before leaving hospital, a nurse may show you how to take care of the catheter. If needed, a community nurse can be arranged to visit your home. If you have any questions, talk with your doctor. In the first few days following surgery, you may feel somewhat uncomfortable or experience pain and so may consider taking pain-killers. If the dose is not sufficient, inform the medical professionals treating you.
A social worker can provide emotional support to you and your family. You can ask your doctor or nurse to meet for a referral to a social worker. Before leaving hospital, a follow-up appointment will be arranged with you.
To slow the growth rate of cancer cells, the doctor may consider removing the testicles to reduce the levels of testosterone in your body. In this surgical procedure a small cut is made in the scrotum. Most men can return home on the same day as the surgery.
The side effects of this surgery can include hot flushes or problems with achieving an erection. After removing the testicles, you may consider having artificial balls implanted to maintain the form of the scrotum.
Hormone therapy can be used in place of surgery to remove the testicles however; it can have the same side effects as surgery.