Choice of treatment for prostate cancer depends on the staging, patient's profile and how widespread is the disease to other organs, according to the Department of Urology, Singapore General Hospital (SGH).
The decision on the choice of treatment depends on the prostate cancer profile. This profile depends on several factors, including:
- Age and expected actuarial survival
- Underlying medical health and the presence of co-existing illnesses, such as myocardial infarction, strokes, diabetes, etc.
- PSA level
- Gleason Score (derived from the pathologist’s assessment of the prostate biopsy)
- Status of DRE (digital rectal examination)
- Stage of disease (extent of prostate gland, lymph nodes or other distant organ involvement)
There are different types of cancer treatments available for people diagnosed with prostate cancer.
Active surveillance of prostate cancer
Selected persons may be closely monitored by blood tests and repeat biopsies. Treatment may be initiated when there is evidence of a change in the cancer parameters. This modality of management is usually used in older men with significant concurrent medical illness, or healthy men with early-stage, low-risk cancer who are willing to comply with the follow-up protocol.
The rationale for active surveillance is based on a calculated probability that the cancer is unlikely to be life-threatening in the next 5-10 years.
In patients with a life expectancy beyond 10 years or with high-risk disease posing a threat, treatment in the form of surgery or radiation is considered.
Surgery for prostate cancer
Those in good health are usually offered surgery as treatment for prostate cancer. Known as radical prostatectomy, this is a surgical procedure to remove the prostate, vas deferens and seminal vesicles. Depending on their cancer profile, the pelvic lymph nodes around the prostate gland may also be removed in selected cases.
This procedure allows the removal of the entire prostate gland, enabling a complete pathological examination. This histological assessment will tell us how advanced the cancer is, the risk of cancer recurrence and if additional treatment is needed. After the prostate gland is removed, the PSA level will drop to undetectable levels. This helps doctors to monitor for recurrence. Radiation can be given after surgery, if necessary, to augment treatment efficacy.
The surgery is performed in two ways:
- Open radical retropubic prostatectomy: The prostate gland with the attached seminal vesicles and vas deferens are removed via a 15 cm incision below the navel in the midline of the abdomen.
- Robot-assisted laparoscopic radical prostatectomy: The same operation is performed via special laparoscopic instruments though 5 to 6 keyhole-sized incisions in the abdomen. These instruments are manipulated by the Da Vinci robotic arms that are controlled by surgeons. This technique allows a magnified, 3-dimensional view of the operating field and allows the exact surgery to be performed with smaller incisions, allowing for faster recovery and less post-operative pain.
Complications of prostatectomy
Some men may experience mild to moderate amounts of urinary leakage especially immediately after surgery. Most patients show significant improvement within three months after surgery. Some may experience difficulties with erection and require additional treatment for erectile dysfunction.