Dear Dr. G,

I was diagnosed with stage I prostate cancer several years ago.

The doctor told me the cancer was still in the early stages as my PSA was only 11, and the scans showed the disease had not spread.

I was given the option of active surveillance and observation of the cancer.

As I was 68-years-old then, my general health was reasonable.

Ten years down the line, my PSA has climbed up to 25.

During the last few years, I have had a heart attack and a minor stroke. Therefore, my general health is not as optimal as before.

I was rather sad to learn the cancer had become more extensive than before.

Although the scan did not reveal metastasis, the doctors described the disease as locally advanced, and will require intervention before too late.

I gathered I am not too suitable for radical surgery, but the doctor proposed an alternative treatment of radiotherapy.

I have looked online about radiotherapy and getting rather confused with all the terminology. I am hoping to put Dr. G on the spot for further clarifications.

Can you tell me whether I was wrongly advised to observe the cancer initially?

What exactly is external bean radiation? Why is the treatment necessary with hormonal manipulation?

I also hear about the seed’s treatment? Is that considered radiotherapy?

Lastly, I am fearful of the after-effects of radiotherapy. Will I end up with sexual dysfunction and urinary incontinence?

Hope to hear from you soon.

Aftermath Anthony

The natural progression of prostate cancer is poorly understood and can be completely unpredictable. On one hand, we understand as men are getting older, many men would die not knowing the existence of uncomplicated prostate cancers, rather than dying of the cancer. Scientists and clinicians are constantly trying to work out the prognostic factors that determine the outcome of the disease and differentiate types of treatments suitable for different individuals. These determinations are purely predictions and the probabilities, based on statistics obtained from other patients.

Younger patients with more aggressive cancers tend to opt for radical prostatectomy to avoid disease progression in the future. However, early and less aggressive cancers in older men are amenable to active surveillance. The monitoring of PSA is an accurate way to determine disease progression, allowing decision for intervention in later stages. Future PSA elevation will require further staging of the disease and subsequent treatment options include radical surgery or radiotherapy, depending on overall patient health and choices.

Radiotherapy is a treatment modality that has been around for many decades. The application of radiation to the diseased tissues has the intention to destroy the cancerous cells, without significant damage to the surrounding tissues. The earlier generation of radiotherapy has a bad reputation of causing significant collateral damage to other organs such as rectum and bladder. In recent years, the accurate mapping with advanced CT scans and cutting-edge accurate delivery of radiation has increased the efficacy of cancer elimination. However, due to the proximity of the prostate to the nerve and vessels supplying the pelvis, complications such as erectile dysfunction and urinary incontinence are still unavoidable.

Another method of maximizing radiation to the prostate without disruption of neighbouring tissues is brachytherapy. The implantation of the seeds into the prostate allows constant delivery of radiation to destroy cancerous tissues. Although the lifespan of the radiation is only up to two years, the seeds are left in-situ without any additional complications. Such intervention has been proven to be very effective in men with a smaller prostate without obstructive symptoms.

Regardless of the type of radiotherapy, the additional treatment with hormonal manipulation is known to be more effective in the treatment outcome. The injection of hormones reduces the size of the prostate to ensure better delivery of radiation. The hormonal treatment also eliminates testosterone that can cause complete reduction of libido. In most cases, the sufferers will also experience erectile dysfunction over three years of hormonal treatment after radiotherapy.

After radiotherapy, men suffering from erectile dysfunction most likely will respond to medications such as the blue pill. The success rate of the medical treatment is around 70%. For those failing medical treatment, other treatment options for erectile dysfunction include intracavernosal injections, vacuum pump devices or even penile prosthesis. The treatment for urge urinary incontinence is medications to make the bladder less sensitive to contraction, with success rates as high as 90%.

When facing the trauma of prostate cancer, it is not unusual for men to think of the aftermath and hold back from exposing himself needlessly to danger. However, the real aftermath of doing nothing with progressing cancer is detrimental.

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