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In considering a process for treatment of prostate cancer, it seems that a man would want to come to a treatment end point that is as close to normal as possible. The conditions should include hopefully killing the greatest number of cancer cells, extending the cancer free time after treatment and minimizing the probability of the cancer return. To effectively accomplish this, you would want to do as little damage to healthy tissue as possible. Unfortunately, to maximize the cancer cell damage, healthy cells are also damaged. So what treatment does the least damage to healthy cells and the most damage to cancer cells? The best answer to this question is yet in the future. For now, we deal with prostate cancer with the best treatments now available.
Clearly for contained cancer, surgery removes most all cancer cells, but also removes the healthy prostate cells, prostate sphincter & urethra. Surgery also removes nerves and damages other nerves. There are other potential complications from surgery.
EBRT targets all tissue, whether cancer or healthy. There appears to be supporting evidence that cancer cells are more susceptible to radiation damage than healthy cells because cancer cells grow faster. In EBRT the cancer cells appear to stop growing and are replaced by scar tissue. Healthy cell damage can take months or years to show up. I have personal experience with colon damage (a few months) and bladder damage (years).
The other treatment options kill cancer and healthy cells indiscriminately. Radioactive seeds kill any cells that are within the kill radius of each seed. Proton beams destroy any cells that are in the target area. Cryo treatment also kills any cells within the kill radius of the probe. This is pretty much the same for all of the alternative treatments, each of which, the end results are very much dependent on the person performing the treatment.
The outcome of any treatment where controlled by humans, especially surgery, depends on the experience of the doctor performing that treatment. EBRT is the only treatment where the end result depends on the man being treated (ie. his physical conditions at start of treatment). I’m lumping a lot together here, as EBRT has initial steps that are controlled by staff/doctors, such as targeting methodology. But once the treatment begins, it is all performed by computers and machines.
Aloha,
Well I did not get it right about prostate surgery. The sphincter associated with the prostate is apparently not removed and is located below the prostate. So after surgery you still have the bladder sphincter and the sphincter that provides orgasm.
Joe
You don't mention HIFU, and of course it would normally fall within the same category as radioactive seeds and cryo in that it kills all cells within the treatment area.
However, there are a number of surgeons who are experimenting with focal treatment using HIFU, in which only part of the prostate tissue is ablated. This is also called hemi-ablation. The advantage of focal treatment is that it gives an even better chance of retaining erectile function and full continence. The downside is that there may be micro-tumours which were undetected in the untreated tissue, which may go on to develop. Additionally, the overall longer term oncological outcomes following full HIFU treatment have yet to be fully demonstrated.
I had focal treatment on 30th October 2009 and my first PSA test about two weeks ago showed a reading of 0.4. Bearing in mind that I still have prostate tissue remaining this is very encouraging. I'm also happy to say that I have full continence and erectile function.
I don't want to make this sound like a commercial for HIFU, but hopefully it may be helpful for people to be aware of focal HIFU treatment.
