The treatment available for Non Metastatic prostate Cancer includes Radical prostatectomy, Radical Radiotherapy and Active Surveillance.
Includes close observation with periodic physical examination, PSA, biopsies at regular intervals. Advantages – Avoids treatment preserves Quality of Life. Disadvantages – Under diagnosis of grade / stage / progress during the surveillance
| Radical Prostatectomy | Radical Radiotherapy | |
|---|---|---|
| Methods | Open/ Laparoscopic/ Robotics | External Beam / IMRT / IGRT/ Cyber knife/ Brachytherapy |
| What does it entails | Operative intervention Remove the whole prostate with vas and seminal vesicles +/- lymph nodes. Patient will have catheter after the op for 7 – 14 days before it is removed. Hospital stay is about 1-2 days. Recovery period – few weeks in Robotics & few months in open surgery | Treatment with radiation Can be from 1 -6 weeks (depending on the modality). Initially scans are performed and then radiation is initiated Usually does not need anaesthesia hospitalisation (except Brachy) Recovery period 4- 6 weeks after radiation is completed. |
| Complications | Bleeding / infection / injury to surrounding tissues. Rectal injury can happen on rare occasion and will need further treatments / operations. | Bleeding / infection / Urinary and feacal urgency can happen and may stay forever. Patients with pre existing urinary difficult may have precipitation of retention. Late secondary pelvic cancers are known to happen rarely. |
| Urinary symptoms | Symptoms like difficult in passing urine/ slow stream.etc will resolve. | Symptoms might improve , usually does not resolve completely and if necessary may need an operation to core the prostate (TURP). |
| Incontinence (urine leakage) | Stress Leak will happen in most patients immediately after surgery & will require 3-4 pads a day. Improves in 2- 6 weeks with active pelvicfloor exercises With time almost all patients will become dry. | Stress leak usually does not happen with RT. Almost all patients experience urinary urgency. Some will have urge leak as well, especially as a late symptom. |
| Erection problems | All patients will experience it after operation. Nerve sparing operation + Viagra will improve erections in some patients. | RT will affect erections in many patients. Brachytherapy appears favourable for preserving erections. |
| Cancer cure / control | Depends on final histopathology (grade/ stage) and PSA at 3 months. Surgical patients have better survival than radiation patients in large retrospective studies (1, 2) | Depends on grade / stage. |
| Long term Local symtoms | As prostate is removed, worsening of urinary symptoms, late obstruction of Ureters, recurrent blood in the urine usually does not happen. | As prostate is still inside, worsening of urinary symptoms, late obstruction of Ureters, recurrent blood in the urine may happen. |
| Further (adjuvant / Salvage) treatment | After operation , if necessary further radiation can be done with no increased risk of complications. | After radiation , salvage operation can be done on very rare circumstances with reasonably high levels of complications. |
1. Abdollah . F Eur Urol 2011
2. Sooriyakumaran P, BMJ 2014
3. www.baus.org.uk
4. www.chennaiurologyclinic.in