Managing and treating your prostate cancer

Your cancer treatment team will advise you about the best treatment for your prostate cancer. Depending on the stage of your cancer, treatment may include surgery, radiation treatment, hormone therapies, chemotherapy and/or palliative care.

If you have early-stage prostate cancer you may be offered treatment options – active surveillance (close monitoring), surgery to remove your prostate, or radiation treatment. Before making a decision about treatment it can be helpful to talk to both a urologist and a radiation oncologist.

Mehemea kua pāngia koe ki te matepukupuku repe ure wāhanga-moata, tērā pea ka whakaratoa koe me ngā whiriwhiringa maimoa – te tirotiro ngangahau (aroturuki tata), te hāparapara ki te tango i to repe ure, te haumanu iraruke rānei. I mua i tō whakatau ko tēhea o ngā maimoatanga me whai koe, he mea pai ki te kōrero ki tētahi kaimātai roma mimi, me tētahi mātanga matepukupuku iraruke.  

 

Treatment summary

 

Stage

Treatment options

Early stage

Active surveillance (close monitoring), surgery or radiation treatment. Cryotherapy (limited availability).

Locally advanced

Surgery and/or radiation treatment, and hormone treatments.

Advanced

Hormone, chemotherapy, radiation treatment, immunotherapy and monitoring with regular follow-up through GP or clinic. Palliative care may also be provided.

 

“In my case the chance of getting all the cancer out with surgery made the decision easier. Some information provided was helpful but then other information was contradictory.”

Nigel

 Active surveillance

If your cancer has a low or very low risk of spreading, you may be offered active surveillance. This is a way of managing your cancer, where the cancer is not immediately treated but is very closely monitored with regular PSA testing (three- to six-monthly), repeated biopsies and MRI scans.

If there is evidence of your cancer becoming active your treatment team will discuss treatment options with you. Active surveillance is often used, as low-risk cancer can pose a low threat to your health.

Some things you might want to discuss with your treatment team:

  • who will be doing the monitoring
  • how often you will be monitored
  • what changes would lead to needing treatment.

“I felt very healthy when I was diagnosed and it was very difficult to hear I had a disease I might not recover from.” Tom

 

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 Surgery for prostate cancer 

If the cancer has not spread beyond the prostate and you are in good general health, the whole prostate gland can be surgically removed. This is called a radical prostatectomy and aims to cure your prostate cancer.

Surgery may also be an option if your cancer has spread to the area just beyond the prostate (locally advanced prostate cancer). This will depend on how far the cancer has spread.

You will need to stay in hospital for a few days after your surgery, and it is normal to go home with a urinary catheter in place for a short time. For most men the recovery time is around six weeks.

Surgery for prostate cancer may be performed using different surgical techniques. Some options are only available through private hospitals.

In each of the procedures, your surgeon will try to save the two bundles of nerves (nerve-sparing radical prostatectomy) attached to the prostate that help you get erections. This surgery is only possible if the cancer is not in or close to these nerves.

Problems with erections are common, even with nerve-sparing surgery. For this reason this procedure is more suitable for younger men with good erectile function and lower-grade prostate cancer.

 

Open radical prostatectomy: Surgery is performed through a cut in the lower abdomen.

 

Laparoscopic (keyhole) radical prostatectomy: Small surgical tools are inserted into several small cuts in the abdomen. A small camera at the tip of a tool allows the surgeon to see what they are doing on a screen. Recovery is often quicker after keyhole surgery than it is if other techniques are used.

 

Robotic-assisted radical prostatectomy: Your surgeon uses a robotic device during the operation, which allows them to use more advanced surgical tools.. This is only available privately in New Zealand.

 

Removing lymph nodes

Removing lymph nodes around the area of the prostate is sometimes done for men with high-risk prostate cancer as part of the treatment.

Side-effects of prostate cancer surgery

The following are possible side-effects of surgery. Talk to your cancer treatment team about how they might affect you. See here for ways to manage them.

 

 Nerve damage

The nerves needed for erections and bladder control lie close to the prostate. During surgery these nerves may be damaged, causing problems with erectile function and bladder control.

 

Erection problems (impotence)

Many men have problems with getting and keeping an erection after prostate surgery. Your ability to have an erection may take up to two years to recover. Some men do not get strong erections again. Men who have had good sexual function before surgery, are young, have small cancers and have nerve-sparing operations are less likely to have problems with erections after surgery.

 

Problems with bladder control

It is normal to have urinary incontinence (loss of bladder control) for a short time after your urinary catheter has been removed. This usually improves over time, particularly if you do regular pelvic floor exercises. A small group of men have longer-term issues with incontinence.

 

Infertility

After your prostate has been removed, semen is no longer ejaculated during orgasm. This is called a dry orgasm and results in infertility.

 

Lymphoedema

If you have lymph nodes removed, fluid may build up in the surface tissues just under the skin on your body. In prostate cancer it may affect the legs, and it can also affect areas including the penis and testicles. It may occur months or years after treatment.

 

Shortening of your penis

You may notice that your penis becomes shorter after surgery, but this may resolve with time.

 

Cryotherapy surgery for prostate cancer

 

Cryotherapy is a procedure that uses needles to apply freezing gases to your prostate. The freezing destroys your entire prostate, including cancer cells. It is used when your cancer is in one place within your prostate. This treatment is only available privately in Tauranga.

 

Radiation treatment

Radiation treatment uses radiation beams to destroy cancer cells or stop them growing. Radiation treatment only affects the part of the body at which the beams are aimed.

 

For more information on how radiation treatment works, see the Cancer Society’s booklet Radiation Treatment/Haumanu Iraruke on our website, www.cancernz.org.nz.

 

When is radiation treatment offered?

If the cancer has not spread beyond the prostate and you are in good general health, you may be offered radiation treatment. Radiation is an alternative to surgery, with similar cure rates but different side-effects.

Radiation treatment may be offered:

  • if you are not well enough for surgery
  • if you have had surgery for locally advanced prostate cancer but there are signs that not all the cancer has been removed
  • to relieve pain caused by secondary cancer in the bones
  • to shrink obstructions in your lymphatic or urinary system
  • where radiation treatment is your preferred treatment option.

 

Treatment is carefully planned to do as little harm as possible to your normal body tissue. The length of treatment will depend on the size and type of the cancer and on your general health.

 

Where radiation treatment is provided

Radiation treatment is available in specialist treatment centres in Auckland, Hamilton, Tauranga, Palmerston North, Wellington, Christchurch and Dunedin. Help may be available for transport and accommodation costs through the National Travel Assistance Scheme. Your treatment centre or your local Cancer Society can advise you on what help may be available.

 

Types of radiation treatment

There are three types of radiation treatment for prostate cancer:

• external beam radiotherapy

• low-dose-rate brachytherapy

• high-dose-rate brachytherapy.

 

types of rad treat2

A room equipped with a machine used for high-dose-rate brachytherapy.

 

1.  External beam radiotherapy

External beam radiotherapy is given from outside the body by a machine called a linear accelerator, onto the area affected by cancer. This is the most commonly used type of radiation treatment for prostate cancer.

 

Treatment is usually given daily, for five days each week, for a period of four to eight weeks. The machine is on for only a few minutes and the total amount of time spent in the treatment room is usually 10 to 20 minutes.

2.  Low-dose-rate brachytherapy (permanent implant)

Low-dose-rate brachytherapy is suitable for low-risk cancer that is confined to the prostate gland. Radioactive seeds are inserted permanently into the prostate gland. This is only available in a few private centres in New Zealand.

 

brachy

After your treatment you will be radioactive and you will need to take special precautions at home. Your radiation treatment team will explain what to do

 

Whai muri i tō maimoatanga ka noho ira rukeruke koe, nō reira, me ata whakarite whakatūpato i tō kāinga. Mā tō rōpū maimoa iraruke e whakamārama, he aha ngā mahi.

 

“I can’t believe they put 123 of those little seeds of different strengths at different locations in something the size of a ping pong ball.”

Paul

 

3.  High-dose-rate brachytherapy (temporary implant)

In high-dose-rate brachytherapy, hollow needles are placed in the prostate and radioactive sources are temporarily placed into the prostate down the needles.

High-dose-rate brachytherapy is usually used in combination with external beam radiotherapy to treat higher-risk prostate cancer. It may also be used alone to treat low-risk prostate cancer.

Side-effects of radiation treatment

You may experience the following side-effects when undergoing radiation treatment:

 

Erection problems

Some men find they slowly develop ongoing erection problems after they have radiation treatment. The nerves needed for erections can be damaged.

Infertility

Radiation treatment usually results in infertility. You may find ejaculation uncomfortable and some men notice that they ejaculate less or not at all. You may experience dry orgasms (where no semen is produced). Your orgasms may feel different from those you are used to.

 

Urinary problems

Radiation treatment can irritate the lining of your bladder and your urethra and you may experience increased urination frequency, a burning sensation while urinating, or difficulty with flow. Some men experience incontinence (leakage) after radiation treatment.

 

Bowel problems

Radiation treatment can irritate the lining of your bowel and rectum (proctitis).You may notice you pass more wind than usual, your bowel motions may be looser and more urgent, and you may feel your bowels have not emptied properly. Occasionally, you may experience pain and bleeding. These effects usually reduce after the end of treatment. With modern radiation techniques, bowel problems are much less common than they used to be.

 

Tiredness and fatigue

You may become increasingly tired during your radiation treatment as your body copes with the impacts. Fatigue is extreme tiredness that can affect your everyday life, energy levels, motivation and emotions. Fatigue and tiredness may last for several months after radiation treatment finishes.

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Hormone treatment for prostate cancer

 

Hormone treatments are used for men with locally advanced or advanced prostate cancer.

 

Prostate cancer needs the male hormone testosterone to grow. Most of a man’s testosterone is produced in the testicles. There are a number of ways to slow the growth of or shrink your prostate cancer by reducing your body’s testosterone levels.

 

Hormone treatments may also be called ‘androgen deprivation therapy’. Androgens (including testosterone) are the hormones that give men their ‘male’ characteristics.

 

Types of treatment include: Luteinising hormone-releasing hormone (LHRH), anti-androgen (hormone) tablets, abiraterone, and orchidectomy.

 

Luteinising hormone-releasing hormone

Luteinising hormone-releasing hormone (LHRH) lowers the amount of testosterone made in the testicles. LHRH therapy is usually given as a monthly or three-monthly injection.

 

Anti-androgen tablets

Anti-androgen (hormone) tablets stop testosterone stimulating the growth of prostate cancer. They are normally used when LHRH therapy is becoming less effective (when the PSA level is rising).

 

Abiraterone

Abiraterone is a hormone therapy that stops your body making testosterone. This treatment is used for men with advanced prostate cancer where other treatments are no longer working.

 

Orchidectomy

An orchidectomy is a small operation where the testicles are removed. This is a permanent procedure. This treatment is not commonly used.

 

Side-effects of hormone treatment

You may find you experience the following side-effects with hormone treatment. Ways to manage your side-effects are described here.

 

Changes in your sex life

You may feel less interested in sex and have difficulty gaining or maintaining an erection. Your testicles and penis may also shrink.

 

Body changes

Hormone treatment can cause weight gain and you may find it causes your breasts to become tender and start to swell. You may notice a loss of strength and muscle mass.

 

You may also experience hot flushes and sweats.

 

Mood changes

You may feel more emotional than you have before. Hormone treatment may increase your risk of depression. If your mood remains low, you lose interest in things or your sleep patterns or appetite change, visit your GP as these can be signs of depression.

 

Tiredness is also a common side-effect.

 

Long-term side-effects

If you take hormone treatment for a long time, your bones may begin to weaken (due to the loss of bone density), and your risk of having a heart attack or stroke may increase.

 

“Through the treatment I lost all my sex drive. It’s a real downer. Luckily I can talk to my wife about this.”

Brent

 

Combined treatment

 

For men with locally advanced or high-risk prostate cancer, hormone treatment may be given to shrink the cancer before giving radiation treatment. This is known as neo-adjuvant treatment and may last for six months or more.

 

Hormone treatment may also be given after surgery or radiation treatment. This is known as adjuvant treatment and may last for up to two years.

 

Other treatments

 

Complementary and alternative therapies

 

Complementary therapies are massage, meditation, acupuncture and other relaxation methods that are used alongside medical treatments. They may help you to feel better and cope more easily with your cancer treatment.

 

Alternative therapies include some herbal and dietary methods that are used instead of medical treatment. Many are promoted as cancer cures. However, none of these methods has been proven to be effective in treating cancer.

 

It is important to let your treatment team know if you are taking any complementary or alternative therapies, because some treatments may be harmful if they are taken at the same time as medical treatments.

 

information resources yellow2For more information on complementary and alternative therapies, see the Cancer Society’s booklet Complementary and Alternative Medicine on our website, www.cancernz.org.nz.

 

 Traditional treatments

 

Traditional Māori healing

Traditional healing has been an integral part of Māori culture for generations. Values, belief systems and teachings from kaumātua and tohunga alike have seen Māori focus on total wellbeing encompassing taha tinana, taha hinengaro, taha wairua and taha whānau (the physical domain, the domain of mind and behaviour, the spiritual domain and the family/whānau or social domain). 

 

When Māori are faced with tough decisions on health care or treatment, some opt for traditional healing methods. These can include rongoā Māori, romiromi or mirimiri to name a few customary remedies based on native plants, massage therapy and spiritual healing.

 

If you are thinking about using these treatments, please talk about them with your radiation treatment team. Both parties aim to provide you with the best possible care that has minimal side-effects. If you have difficulty expressing your needs to your treatment providers, find someone to advocate on your behalf, so that both traditional Māori healers and hospital treatment specialists are able to work together to support you on your cancer journey.

 

Pacific traditional healing 

Traditional healing has long been used by Pacific people to help in their recovery. It involves taking a holistic approach to treating the person, where their mental, emotional, physical and spiritual needs are looked after together, rather than as separate parts. The treatment offered to each person can vary and depends on their needs. Medicinal plants and herbs may be used during the treatment process, as well as stones and massage.

 

 

questions3Questions you might like to ask your treatment team

 

You might like to find out:

 

  • if treatment will affect your sex life and your fertility, and if so, what can be done to help manage these side-effects
  • if your diet needs to change and who to talk to about it
  • what other side-effects you might experience
  • if you will be able to drive after treatment
  • if your cancer is likely to be hereditary
  • what the chances might be of your cancer coming back after treatment(s)
  • what you can do to help improve your outcome
  • how your PSA levels and your prostate cancer will be monitored after treatment.

 

 

 

 

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