Localized Prostate Cancer Treatments (Stage I or II)

If your prostate cancer is confined to the gland, or localized (Stage I or II / low Gleason score), you are a good candidate for treatments that can result in long-term survival. There are three main approaches to managing localized cancer: Watchful waiting, surgery, and radiation therapy.

Watchful waiting is based on the premise that the localized prostate cancer may advance so slowly that it is unlikely to cause men – especially older men – any problems during their lifetimes. Some men who opt for watchful waiting have no active treatment unless symptoms appear. They are often asked to schedule regular medical checkups and to report any new symptoms to the doctor.

In addition to early stage prostate cancer, watchful waiting is also recommended for small, slow-growing cancer, or for older men or men with serious medical conditions who may not handle treatment very well.

Surgery is a common treatment for early stage prostate cancer and may be recommended for patients who are in good health and younger than age 70.

Radical prostatectomy is usually recommended for early-stage cancer that has not spread to other tissues or organs. This procedure makes the patient essentially "cancer free."

During a radical prostatectomy the surgeon removes the entire prostate gland and sometimes lymph nodes, along with both seminal vesicles, both ampullae (the enlarged lower sections of the vas deferens) and other surrounding tissues. In "nerve-sparing" radical prostatectomy, the nerves to the penis that control erections are preserved.

Radical prostatectomy typically requires general anesthesia and takes two to four hours. The patient stays in the hospital for three days, and needs to wear a tube to drain urine for 10 days to 3 weeks. Newer techniques for radical prostatectomy such as laproscopic and robotic prostatectomy are also available.

• Surgery-related complications, such as bleeding, infection or cardiovascular problems
• Loss or urinary control, called incontinence
• Loss of the ability to achieve or maintain an erection

Side effects may be temporary or permanent, depending upon the patient’s age, extent of disease and type of surgery.

Also known as "irradiation" or "radiotherapy", radiation therapy uses high energy X-rays, either from a machine (external beam radiation therapy) or emitted by radioactive seeds implanted in the prostate ("seed implantation" or brachytherapy, to kill cancer cells. When prostate cancer is localized, radiation therapy serves as an alternative to surgery or it may be used after surgery to kill remaining cancer cells.

External beam radiation therapy generally involves treatments 5 days a week for 6 to 7 weeks. If the tumor is large, hormonal therapy may be started at the time of radiation therapy and continued for several years.

• Diarrhea
• Inflammation of the rectum ("radiation colitis")
• Inflammation of the bladder ("radiation cystitis")
• Problems with urination
• Fatigue
• Impotence

With "seed implantation" or brachytherapy, the implantation procedure is completed in an hour or two under local anesthesia; the patient typically goes home the same day.

• Post-implant pain in the rectum
• Incontinence
• Difficulty in urination (frequency, retention)
• Inflammation of the prostate (uncommon)
• Sexual impotence (uncommon)