Choosing between Radiotherapy and Surgery
Choosing between surgery or radiotherapy can be a verydifficult process for patients. Both of them are recognised as very viable options for treatment of localised prostatic cancer. The object of both isto cure the disease. However, there are pros and cons to each one.
Surgical Options and It’s Side-Effects:
1 – Erectile Dysfunction
For example if we talk about the surgical option and removal of the prostate, one of the commonest side effects of that is erectile dysfunction. That can occur even when we spare the nerves. These are the nerves which travel right alongside back of the prostate and actually supply the penis with erectile function. When you remove the prostate those nerves can get damaged. Even if we make a special effort to preserve those, nerves because they’re so fragile, they can still have damage. This can be either temporary or even permanent. This can then lead to erectile dysfunction. If a man is in his middle age and is very sexually active, that can obviously be a real impact on his quality of life.
2 - 尿失禁
因此，如果我们要进行手术而不是放射治疗，我们需要非常确定或非常自信，即确实需要进行这种手术，以便在前列腺癌方面改善该人的结果。由于勃起功能障碍非常普遍，因此在患者做出任何决定之前，需要完全理解。根治性前列腺切除术的另一个潜在并发症是尿失禁。
Almost all men after having surgery will initially have a degree of leakage of urine or urinary incontinence. However, at least 90% of men will eventually regain full control of their bladder. This means that they don’t need to wear any pads at all. However, that can take weeks, sometimes it can even take months. So there’s gonna be a period where that man is gonna have to wear pads and do pelvic floor exercises. These exercises will help to accelerate the recovery of their bladder control.
So these are really the two main risk factors, or complications, that can occur with radical prostatectomy.
放射疗法及其副作用:
1 – Erectile Dysfunction is Possible but Not Always
Now, there are different side effect profiles between surgery and radiotherapy. If we compare it to brachytherapy, which is implantation of radioactive seeds, actually there are some similarities. This includes there being a risk of erectile dysfunction. Particularly for tumours that are occurring around the posterior aspect of the prostate, which is right alongside the nerve. A good dose of radiotherapy is going to be required in that area in order to kill the cancer cells. However, that dose might also affect the erectile nerves and so erectile dysfunction is very common as well.
2.降低尿失禁的风险
但是，尿失禁少。这是放射疗法的明显优势，因为您实际上并没有影响括约肌，这是圆形肌肉实际上控制延续性的。但是，近距离放射治疗的缺点之一是因为辐射可以在前列腺的寄宿生之外扩散，它会影响周围的器官。我们已经谈到了勃起的神经，但也会影响膀胱底座。
3 – Increased Risk Bowel Weakness
As a result of this affect you can get what’s called radiation cystitis, or radiation inflammation of the bladder and that can cause irritation of the bladder. This irritation then leads to urgency and frequency of urination. Now whilst that’s not a common side effect, if it occurs it can be quite impactful in terms of quality of life. There is now available longterm or longitudinal quality of life data that demonstrates that and similarly for the bowel. Because the prostate sits right in front of the rectum and therefore, that front wall of the rectum can also potentially receive a dose of radiotherapy, or radiation. As a result, you can get radiation proctitis, or inflammation of the rectum, due to radiation. Again this can lead to urgency and frequency of opening one’s bowels. Lastly, you can also have, occasionally, bleeding from either the bowel or the bladder from that.
因此，患者必须在他的脑海中权衡他可能能够更好地忍受这两种选择中的哪一种。
副教授Jeremy Grummet博士– Urological surgeon and Director of Clinical Research in Urology at Alfred Health. Member of Australian Urology Associates private practice group
