You may want to get a second opinion. Your doctor should not mind your doing this. In fact, some insurance companies require you to get a second opinion. You may not need to have tests done again since the results can often be sent to the second doctor. If you are in an HMO (health maintenance organization), find out about its policy concerning second opinions.

Each type of treatment has benefits and drawbacks. There may be side effects. Your age, your overall health, and the stage and grade of your cancer are all factors to consider. Surgery, radiation, and hormone treatment are the most common treatments for prostate cancer. Chemotherapy may be used in some cases, and watchful waiting, though not actually a treatment, may be an option for some men. Each of these approaches is explained below.

Local Treatment

Surgery

The two most common surgical procedures for treating prostate cancer are radical prostatectomy and nerve-sparing prostatectomy. Prostatectomy is recommended only for patients with localized cancer (confined to the prostate). Both types of prostatectomy take from 1 ½ to 4 hours and usually require a hospital stay of three days. Patients should expect to keep the catheter, which is placed into the bladder through the penis while the patient is still under anesthesia, for ten days to three weeks after the surgery.

In a Radical prostatectomy, the entire prostate gland, both seminal vesicles, both ampullae and some surrounding tissue are removed. The prostate is reached through an incision in the lower abdomen which also allows lymph nodes to be removed for dissection.

Because radical prostatectomy requires the section of urethra that runs through the prostate to be cut away, along with some of the sphincter muscle that controls the release of urine, most patients experience a lack of bladder control (incontinence) during the first several weeks or months following the surgery. Mild stress incontinence, that is, passing a small amount of urine when coughing, laughing, sneezing, or exercising may occur permanently in up to 35 percent of men. Only a few men experience permanent incontinence or stool incontinence, due to muscle damage or reduced elasticity in the rectum incurred during the surgery.

Radical prostatectomy may involve the cutting, stretching or removal of the two neurovascular bundles of nerves and blood vessels that are needed for an erection, which may result in short-term to permanent impotence. During the first three months to one year after the surgery, most men will not be able to get an erection without using medication or some other treatment. A man’s chances of permanent impotence are affected by his age, the extent of his disease, the type of surgery performed and any prior history of impotence. Almost all men become impotent after this type of surgery.

The risk of permanent impotence may be reduced by Nerve-sparing prostatectomy. Depending on the size of the cancer and its location to the nerves, sometimes the prostate can be removed without damaging the two neurovascular bundles alongside the prostate. It is not possible, however, for the surgeon to determine whether either of the bundles can be avoided until the operation is underway. The goal of a prostatectomy is to eradicate the cancer as thoroughly as possible, and this goal will not be compromised in order to sustain nerve functioning. Therefore, this procedure still involves the chance of short-term to permanent incontinence and impotence, and most men undergoing nerve-sparing prostatectomy still lose a degree of sexual function.

Cryosurgery

Cryosurgery involves placing a small metal tool into the tumor and killing the cancer by freezing it. The probe is placed through an incision between the anus and the scrotum. Spinal or epidural anesthesia is used during this procedure. Men usually remain in the hospital for one or two days.

A catheter is also put in place so that when the prostate swells, urine does not collect in the bladder. The catheter is removed one or two weeks later. After the procedure, there will be some bruising and soreness of the area where the probe was inserted.

Freezing can damage nerves near the prostate and cause impotence and incontinence. These side effects occur about as often as they do after radical prostatectomy. In addition, freezing may damage the bladder and intestines, leading to pain, a burning sensation, and the need to empty the bladder and bowels often.

Short-term results for cryosurgery look encouraging, although it is not yet known if the long-term survival rates are as high as with standard treatments. For now, this procedure is an option mostly for men who cannot have surgery or radiation therapy.

Radiation Therapy

Radiation therapy is another way to treat prostate cancer. In this treatment, high-energy X-rays are used to kill cancer cells. Radiation is used most often for cancer that has not spread outside the prostate gland, or has spread only to nearby tissue. If the disease is more advanced, radiation may be used to shrink the tumor and provide pain relief. While radiation usually eliminates the need for surgery, men who do not have a good response to radiation might still have surgery at a later date.

Two methods of giving radiation are used to treat prostate cancer:

External beam radiation is much like getting a regular X-ray, but for a longer time. Each treatment lasts only a few minutes. Patients usually have five treatments per week on an outpatient center over a period of seven or eight weeks. The treatment itself is painless.

Side effects can include diarrhea, with or without blood in the stool, and irritated intestines. Sometimes, normal bowel function does not return after treatment is stopped. Both during and after treatment, other side effects might include frequent urination, feeling like you have to urinate all the time, burning while urinating, and blood in the urine.

Also, external radiation therapy can cause tiredness that may not go away until a month or two after treatment stops. In about half the men, some degree of impotence may occur within two years of radiation. Impotence usually does not begin right after treatment (as it often does with surgery) but develops slowly over one or more years.

Internal radiation uses small radioactive pellets (each about the size of a grain of rice) placed directly into the prostate. They may be permanent or temporary. Because they are so small, they cause little discomfort and are simply left in place after their radioactive material is used up. In another method, needles containing a higher amount of radioactive material can be used to place the material for less than a day. This approach is called high dose rate brachytherapy. For about a week after the needles are put in place, there may be some pain in the area and a red-brown color to the urine.

While radiation therapy can be used as the main treatment for prostate cancer, it can also be used to treat bone pain for cancer that has spread to the bone. Strontium 89 (Metastron) is the substance used for this purpose.

Side effects of internal radiation therapy can include impotence, urinary incontinence, and bowel problems. Rectal problems such as burning, pain, and diarrhea may occur in a small number of men. They can be hard to treat once they develop. Impotence is less likely to be a problem after internal radiation than after surgery or external beam radiation. Be sure to talk to your doctor if you have any of these side effects. Often there are medicines or other methods to help.
 

Systemic Treatments

Chemotherapy

Chemotherapy is used for patients whose prostate cancer has spread outside of the prostate gland and for whom hormone therapy has failed. It will not destroy all the cancer cells, but it may slow tumor growth and reduce pain. Chemotherapy is not used as a primary treatment for men with prostate cancer.

Chemotherapy uses drugs to kill cancer cells. The drugs are given in the form of shots or pills. While these drugs kill cancer cells, they also damage some normal cells causing side effects.

The side effects of chemotherapy depend on the type of drugs, the amount taken, and the length of treatment. These side effects might include nausea and vomiting, loss of appetite, loss of hair, and mouth sores. Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can increase the chance of infection, and cause bleeding or bruising after minor cuts or injuries, as well as tiredness.

Most side effects go away once treatment is over. If you have problems with side effects, talk with your doctor or nurse. There are remedies for many of the side effects of chemotherapy, such as drugs to prevent or reduce nausea and vomiting.

Hormone Therapy

Hormone therapy is often used for men whose cancer has spread to other parts of the body or has come back after earlier treatment. While hormone therapy does not cure the cancer, it can provide relief from symptoms.

The goal of hormone therapy is to lower the levels of the male hormones or androgens. The main androgen is called testosterone. Androgens, which are produced mostly in the testicles, cause prostate cancer cells to grow. Lowering androgen levels can make prostate cancer shrink or grow more slowly.

There are several methods used for hormone therapy. Most involve giving various drugs to lower the amount of testosterone or to block the body's ability to use androgens. Some of these drugs are called LHRH analogs or agonists. They are given as shots either monthly or every three months.

Another method, however, is surgery to remove the testicles. This operation is called an orchiectomy (castration) and is mentioned here because it works by removing the main source of male hormones.

Other drugs called anti-androgens are given as pills, once or three times a day. They may be used along with orchiectomy and the LHRH analogs to provide total androgen blockade,or total blocking of all androgens produced by the body.

Hormone treatment can have serious side effects. These vary and depend on the kind of treatment, hormone, or drug you are taking. About 90% of men who have an orchiectomy have reduced or no sexual desire and impotence. There may also be temporary hot flashes, breast tenderness and growth of breast tissue.

All treatments that lower testosterone levels can cause infertility, loss of interest in sex, not being able to have an erection, and hot flashes. You should feel free to talk to your doctor or nurse about these side effects before you begin treatment.

If you are having hormone therapy, ask you doctor to explain which drugs are being used and what side effects you might expect to have.
 

Watchful Waiting

Men whose symptoms are mild often opt for an approach called watchful waiting. This means that they report for regular checkups and have further treatment only if and when their symptoms become too bothersome.

The USPHS Clinical Practice Guidelines call watchful waiting "an appropriate treatment strategy for the majority of patients." Men who choose watchful waiting should have regular, perhaps annual, check-ups, including DREs and laboratory tests.

For those who choose watchful waiting, a number of simple steps may help to reduce bothersome symptoms. These include limiting fluid intake in the evening, especially beverages containing alcohol or caffeine, which can trigger the urge to urinate and can interfere with sleep; taking time to empty the bladder completely; and not allowing long intervals to pass without urinating.

Men monitoring prostate conditions should also be aware that certain medications they are taking for other ailments may make their symptoms worse. These include some over-the-counter cough and cold remedies, prescribed tranquilizers, antidepressants, and drugs to control high blood pressure. Switching to a different prescription may be helpful.