Most people expect cancer to be treated by surgical removal of all or part of the organ in which it occurs, as in cancer of the breast in women, cancer of the testis, cancer of the kidney and in many other types of the disease. Although a famous urologist called Hugh Hampton Young working at The Johns Hopkins Hospital in America first described radical prostatectomy in 1905, the operation that removes the whole prostate gland is done on only a few men with cancer of the prostate. The reason that it is not common is that cancer. If the prostate can be difficult to detect until it has grown outside the prostate gland. Once this has happened, it is impossible to remove all the cancer by surgery and so an operation will not cure the disease.
Although doctors can now diagnose cancers at an earlier stage, many small early cancers grow very slowly and can take as long as 10 years to cause trouble. Obviously, for a man of, say, 85 years old, this sort of tumour is not going to be dangerous and at this age he would not stand up to major surgery very well. For this reason, removing the prostate as a treatment for cancer is only done in younger patients and when there is reason to believe that the cancer is going to grow fairly quickly. Usually the operation is only recommended to men under 70, although the exact age depends on individual fitness.
Radiotherapy can destroy small tumours and thus cure the cancer, so it is an alternative to radical prostatectomy. It may be suggested if the patient is not fit for an operation, and some men choose it in preference to surgery. Although removing a tumour completely by an operation may seem more satisfactory, there is no definite proof that one treatment cures the disease better than the other.
Radiotherapy can also be used when surgery is not possible because the cancer has spread outside the prostate. Here it may not ‘cure’ the cancer but, by shrinking it, it will prevent the cancer from causing trouble and may reduce the chances of it spreading further.
Wait and See
As many tumours are not immediately dangerous, some patients may be advised that they need no immediate treatment. This does not mean they are being neglected, and it is important that they are seen regularly, so that tests can be done to check that the cancer is not advancing. If it is, treatment might then be advised. Sometimes the tests will show that the tumour is growing so slowly that it is safe to discharge the patient from the hospital clinic, although he will be advised to keep in touch with his GR.
If treatment for cancer when it is at an early stage, and confined to the prostate gland, is recommended, a discussion will usually take place about the choice of treatment. Because the best treatment for early cancer of the prostate is uncertain, a man with the disease should expect to be informed of the possibilities and given a major say in deciding what is done.
Radical prostatectomy involves removal of the whole prostate gland. This is different from operations for BPH, where even the open operation only takes out the inner enlarged part of the gland. The prostate gland can be removed either through an incision in the lower abdomen or from below by an incision in front of the back passage. Either before or at the same time (possibly by a laparoscopic ‘keyhole’ operation), the lymph nodes (glands) at the side of the prostate will be removed and checked to make sure that there is no sign of the cancer spreading. Removal of these nodes causes no harm. If there is no cancer in them, the prostate gland is removed, cutting the urethra below the prostate and removing the prostate from the neck of the bladder, which is then stitched back onto the urethra. A catheter is left in place, usually for two weeks, while healing takes place. Most men get over the immediate effects of the operation quickly enough to go home after a few days with the catheter in, returning to hospital to have it removed.