Complete surgical removal or radiation of the entire prostate are the “gold standards” for treatment of localized prostate cancer. But they often produce distressing side effects—notably impotence, incontinence (loss of urinary control), and rectal problems—at least for a time. Now two variations on those therapies promise to reduce the impact of treatment on men’s quality of life.

Local treatment
One possibility is focal surgery, which Thomas J. Polascik, MD, of Duke University’s Prostate Center and Division of Urologic Surgery, likens to lumpectomy for breast cancer, where only the tumor and a small margin of tissue are removed rather than the entire breast. Dr. Polascik’s team examined nearly 1,200 whole prostates removed during surgery to investigate how many men might be candidates for this approach. “One in five had a small, localized cancer that could have been treated by therapy that targeted just one lobe of the prostate,” Dr. Polascik says.

Removing just the affected lobe offers greater odds of maintaining urinary continence and sexual function without sacrificing efficacy.

Brachytherapy
For men who prefer radiation, low-dose brachytherapy appears to be as effective as standard radiation while providing a better chance of preserving erectile function and urinary control. Brachytherapy involves implanting radioactive “seeds” into prostate tumors. The seeds slowly release radiation, causing the tumors to shrink.

In a study of 131 men with good erectile function whose prostate cancer was treated with seed implantation, erectile function was preserved in 92% of those between the ages of 50 and 59. Continence was also maintained.

But erectile dysfunction is a late effect of radiation, cautions Jamie Cesaretti, MD, assistant professor of radiation oncology at Mount Sinai School of Medicine in New York. “It happens several years after the therapy—unlike with surgery. So we need to follow the treated patients for several more years to get a complete answer.”