Prostate cancer treatment tips.

The treatment options for prostate cancer depend in part on whether the tumor has spread. For tumors that are still inside the prostate, radiation therapy (using x-rays that kill the cancer cells) and a surgery called radical prostatectomy are common treatment options. "Watchful waiting" is also a treatment option. In this approach, no treatment is given until the tumor gets bigger. Watchful waiting may be the best choice for an older man who has a higher risk of dying from something other than his prostate cancer.

Generally, tumors that have grown beyond the edge of the prostate can't be cured with either radiation or surgery. They can be treated with hormones that slow the cancer's growth.

What is radical prostatectomy?
Radical prostatectomy is a surgery to remove the whole prostate gland and the nearby lymph nodes. Most men who have this surgery are under general anesthesia (puts you into a sleep-like state). After the prostate gland is taken out, a catheter (a narrow rubber tube) is put through the penis into the bladder to carry urine out of the body until the area heals.

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What are the risks and benefits of radical prostatectomy?
If you're 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 and complications. 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. The main risks of this surgery are incontinence (lack of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Fortunately, only a very low percentage of men have severe incontinence after radical prostatectomy. Up to 35% of men have a little accidental leakage of urine during heavy lifting, coughing or laughing.

The chance of impotence decreases 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 under 50 years old when you have this surgery, you're likely to regain sexual function. If you're older than 70, you're more likely to lose sexual function. Remember, even if the nerves are cut, feeling in your penis and orgasm remain normal. Only the ability to get a rigid penis for sexual intercourse is lost. However, there are medicines and devices that can help make the penis rigid.

What is the purpose of hormone therapy?
The purpose of hormone therapy is to lower the level of the male hormones, called androgens, which are produced mostly in the testicles. This is because androgens, such as testosterone, help the prostate tumor grow. Monthly shots can be given or the testicles can be surgically removed. Once the testosterone is out of your body, the prostate cancer usually shrinks. Hormone treatments are most often used in patients with cancer that has already spread beyond the prostate gland.

While prostate cancer usually responds to 1 or 2 years of hormone therapy, after some time most tumors start to grow again. Once this happens, the treatment goal is to control symptoms. No treatment can cure prostate cancer after hormone therapy stops helping.

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