Prostate cancer is the second most common cause of cancer-related deaths among men. The dramatic increase of prostate cancer has led to heightened awareness, increased screening and improved treatment options.

It is imperative that a patient has enough information to make an informed decision in consultation with his doctor about the most appropriate treatment plan. Many treatments, although effective, may have severe side effects or complications that raise significant questions regarding the patient's quality of life. Several considerations must be made when determining the most suitable treatment for prostate cancer: the progression of the disease, the risk of recurrence, treatment cost, side effects and the overall impact on the patient's quality of life.


OVERVIEW
  • Targeted Cryosurgery (TCAP):
    Minimally invasive procedure in which prostate gland undergoes deep freezing to destroy cancerous cells. Ultrasound visualization and temperature monitoring allow physician to target prostate gland and protect surrounding tissue.

  • Radical Prostatectomy (RP):
    Major surgical procedure in which entire prostate gland and some surrounding tissue is removed.

  • External Beam Radiation:
    A 6-8 week treatment in which a beam of radiation is delivered from outside the body through healthy tissue to stop the growth of cancerous cells

  • Iinternal Radiation Implants (Brachytherapy):
    Permanent implantation of 80 to 100 radioactive pellets into the prostate gland. The pellets give off radiation for months and then remain dormant. Pellets remain in the body permanently.

RISKS/SIDE EFFECTS
  • Targeted Cryosurgery (TCAP):
    • 1% of patients report incontinence (7)
    • 85% of patients report impotence (8)
    • Urinary tract obstruction is less common than with RP (9)

  • Radical Prostatectomy (RP):
    • 23% of patients report incontinence (2)
    • 89% of patients report impotence (3)
    • Urinary tract obstruction is common (4)
    • Risks of major surgery include potential for heart attack, stroke, blood clots, anemia and infection. Death can occur in rare cases (5)
    • Blood transfusions are common (6)

  • External Beam Radiation:
    • 10% of patients report incontinence (10,11)
    • 29% of patients report impotence (12,13)
    • Urinary tract obstruction is less common than with RP or targeted cryosurgery (14)
    • Side effects may include diarrhea and blood in the stool. Occasionally normal bowel function doesn't return. (15)

  • Iinternal Radiation Implants (Brachytherapy):
    • Danger of radiation exposure for the patient and his family.
    • Inital obstructive and irritative urinary symptoms are common; 4% are prolonged (16)
    • 10-30% of patients report impotence (17)
    • Significant rectal problems (burning, pain and diarrhea) may occur in up to 5% of patients and are difficult to treat (18)

RECOVERY
  • Targeted Cryosurgery (TCAP):
    • Patients can resume a normal lifestyle immediately after TCAP, but strenuous activity should be avoided for one month
    • Some patients experience 2 to 3 days of minor discomfort

  • Radical Prostatectomy (RP):
    • 3 to 5 week recovery period (19)
    • Procedure lasts 1.5 to 4 hours, followed by an average hospital stay of 3 days (20)

  • External Beam Radiation:
    • Procedure takes a few minutes and involves treatment 5 days per week for 6 to 8 weeks (23)
    • Radiation therapy may cause fatigue for 1 to 2 months after treatment stops (24)

  • Iinternal Radiation Implants (Brachytherapy):
    • For about a week following implantation, patients may have pain in perineal area and/or red-brown discolouration of urine (26)
    • 5% of patients develop significant rectal problems (burning, pain and diarrhea) (27)

EFFICACY
  • Targeted Cryosurgery (TCAP):
    97% of patients have negative biopsy at 12 months (22)
    82% of patients have negative biopsy at 5 years

  • Radical Prostatectomy (RP):
    78% of patients have no evidence of disease long-term (21)

  • External Beam Radiation:
    56% of patients have negative biopsy long-term (25)

  • Iinternal Radiation Implants (Brachytherapy):
    78% of patients have negative biopsy long-term (28)



REFERENCES

  • (2) Fowler et al. "Patient reported complications and follow up treatment after radical prostatectomy." Urology. 42:622-629, 1993.
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  • (3) Fowler et al. "Patient reported complications and follow up treatment after radical prostatectomy." Urology. 42:622-629, 1993.
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  • (4) Badalament et al. "Patient reported complications after cryoablation therapy for prostate cancer." Urology. (Submitted).
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  • (5) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (6) Beyer et al. "Biochemical Disease-free Survival Following Prostate Implantation." International Journal of Radiation Oncology. 37(3):559. 1997.
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  • (7) Badalament et al. "Patient reported complications after cryoablation therapy for prostate cancer." Urology. (Submitted).
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  • (8) Badalament et al. "Patient reported complications after cryoablation therapy for prostate cancer." Urology. (Submitted).
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  • (9) Badalament et al. "Patient reported complications after cryoablation therapy for prostate cancer." Urology. (Submitted).
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  • (10) Jonler et al. "Sequelae of definitive radiation therapy for prostate cancer localised to the pelvis." Urology. 44:876-882, 1994.
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  • (11) Crook et al. "Effect of pelvic radiotherapy for prostate cancer on bowel, bladder, and sexual function: The patient's perspective." Urology. 47:387-394, 1996.
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  • (12) Widmark et al. "Self-assessment questionnaire for evaluation urinary and intestinal late side effects after pelvic radiotherapy in patients with prostate cancer compared with an age-matched control population." Cancer. 74:2520-2532. 1994.
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  • (13) Jonler et al. "Sequelae of definitive radiation therapy for prostate cancer localised to the pelvis." Urology. 44:876-882, 1994.
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  • (14) Badalament et al. "Patient reported complications after cryoablation therapy for prostate cancer." Urology. (Submitted).
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  • (15) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (16) Chiusano et al. "Use of Pre-deposited Autologous Blood Plus Intraoperative Auto Transfusions Compared with Pre-deposited Autologous Blood in Radical Retro Public Prostatectomy." JAMOSTEO, 96:160-164. 1996.
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  • (17) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (18) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (19) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (20) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (21) Elgamal et al. "Ten-year disease free survival after transperineal sonography-guided treatment." Cancer. 83:989-1001. 1998.
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  • (22) Chinn et al. "A New Device for Prostate Cryosurgery: A Multicenter Experience." Presentation at 1998 World Endurology Conference. 1998.
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  • (23) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (24) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (25) Crook et al. Journal of Urology.159(5): 239A. 1998.
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  • (26) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (27) American Cancer Society, "The Prostate Cancer Resource Center: Treatment. http://www.cancer.org. December 20, 1998.
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  • (28) Ragde, Cancer. 83(5):989. 1998
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