The following is a list of treatment options for clinically localised prostate cancer. It is important to note that no treatment is effective 100% of the time. Please note that this is a general summary and treatment options will vary depending on your individual situation.
Not all prostate cancers that are detected are considered to be clinically significant. Active surveillance aims to prevent the overtreatment of clinically insignificant cancers that may never cause you a problem. If the prostate cancer appears to be potentially insignificant then it is monitored periodically with PSA tests and repeat biopsies. If it appears that the cancer is progressing then active primary therapy can be performed at that stage. The criteria for active surveillance are yet to be fully defined but generally include low volume low grade disease. Active surveillance protocols continue to be defined and are yet to be fully validated. The timing of when to intervene is ill-defined and studies are currently underway to determine what constitutes disease progression and when to intervene.
Surgery involves complete removal of the prostate gland. It is highly effective treatment with good long term results in the appropriately selected patient; the major long-term side-effects of surgery include impotence and incontinence.
Impotence - The risk of impotence varies depending on your age and health and whether the nerves to the penis are removed or whether one or both of them are spared. If you have excellent erections before the operation, your chance of regaining your erections at 1 year either spontaneously or with tablets is approximately 70% if both nerves are spared and 20-30% if only one is spared. Erections tend to improve over time for 1-2 years after the surgery but it is possible that they may never return and you would need to consider using a vacuum pump, injections or possibly require prosthesis to achieve intercourse. Should your erections recover sufficient for intercourse, it is important to note that they are not likely to be as strong as prior to the operation. It is highly likely that you will need to use tablets (Viagra, Cilais, Levitra), injections or vacuum devices for some time (months / years) after the operation.
Incontinence - You should expect that you are likely to leak urine after your operation and will need to wear continence pads for the first few weeks or months. It is vital that you perform pelvic floor exercises. In general 25% of patients are pad free within 1 week, 70% within 3 months and 90% at 1 year. Therefore there is a 10% chance that at 1 year after the operation you will need to wear incontinence pads. Usually this is a security pad to catch small amounts of urine however approximately 2% of patients have severe incontinence which may require further surgery by way of injectable agents, a male urethral sling or an artificial sphincter. There is a chance that the incontinence will be permanent.