Treatments for early-stage prostate cancer

In the past, the most common surgery to treat prostate cancer was an open radical prostatectomy, which involved making a cut between the belly button and pubic bone and opening the pelvis. Thanks to the availability of advanced technology, most surgeons now perform a robotic-assisted laparoscopic prostatectomy instead.

“With a robotic-assisted laparoscopic prostatectomy, a surgeon makes small incisions in the abdomen and inserts special robotic instruments that are precisely controlled by the surgeon,” says Dr. Hatcher. “This makes for a much less invasive procedure, which can result in less pain, less blood loss, and a shorter hospitalization than open surgery.”

Side effects from surgery, such as urinary incontinence and erectile dysfunction, can occur. And according to Dr. Hatcher, the recovery period can last anywhere from several weeks to several months or longer. “The duration is variable and depends on many factors, including the stage of the cancer, and the patient’s age and baseline function,” he says.

However, with appropriate management and time, most men can return to a normal lifestyle.

External beam radiation therapy involves targeting the prostate with tightly focused beams of radiation. A course of radiation may be given daily, Monday through Friday, 15 minutes per day for 5 to 8 weeks, using a technique called intensity modulated radiation therapy (IMRT), which is a high-precision radiotherapy. Alternatively, treatment may be compressed into five treatments using stereotactic body radiotherapy (SBRT), which gives high-dose, highly precise radiation from different angles around the body. If there is concern the cancer may have spread to the pelvic lymph nodes, these can be targeted as well with IMRT.

External beam radiation is a noninvasive treatment, given on an outpatient basis. Dr. Jabbari says side effects from SBRT and IMRT can include temporary urinary and bowel symptoms, mild fatigue and potential erectile dysfunction. “However, radiation is usually well tolerated with a relatively low risks of complications,” he adds. 

Brachytherapy is a form of “internal” radiation, which involves a procedure with anesthesia in the operating room to implant radioactive seeds in the prostate. There is a low risk of complications, and it usually has similar side effects as external beam radiation.