Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Cancer Care

Fremont and San Leandro Medical Centers

Overview

Prostate cancer is the most common cancer in men (other than skin cancer). It is usually first detected through an elevated level of prostate-specific antigen (PSA), an abnormal prostate exam, or other symptoms that cause us to suspect prostate cancer. Treatments for prostate cancer may include:

  • Active surveillance.
  • Surgery.
  • Radiation therapy, including brachytherapy and/or external-beam radiation therapy.
  • Hormonal therapy.
  • Chemotherapy.
  • Immune therapy.
  • Some combination of the above.

While there are a variety of treatment options for prostate cancer, the approach depends upon the type and severity of each individual cancer. After a full diagnostic analysis, we will work with you to create the best treatment plan for you. 

Your age and general health are important determining factors in addition to your perspectives on the potential side effects that may be associated with each type of therapy.

Active Surveillance

If we find that your prostate cancer is at an early stage and is slow growing, we may not recommend immediate treatment. We will discuss the risks and benefits of postponing treatment.

We will also discuss the side effects of treatment, such as incontinence, sexual dysfunction, or bowel problems that can sometimes be long-term. We will also take into account your age and any other serious health issues that you may have. Active surveillance may be an option if you have a less aggressive cancer. It is considered an option when:

  • Your Gleason score is 6 or less. (In some cases, active surveilance can also be considered for a Gleason score of 7.)
  • No more than one-third of your biopsy samples are positive.
  • No more than 50 percent of any sample contains tumor cells.
  • The PSA score is less than 10.

During active surveillance, we will closely monitor you for any signs of disease progression. Disease progression refers to either increase in the amount of cancer and/or increase in the Gleason score of your cancer. Active surveillance includes: 

  • Periodic PSA tests 
  • Prostate exams 
  • Repeat prostate biopsies 

If the tests show that the disease has progressed, we generally recommend treatment, with either surgery or radiation.

Most men who are candidates for active surveillance generally do well and are able to continue their program of surveillance or opt for treatment if it becomes necessary. It is important to recognize that, for a small percentage of men, their cancers may continue to progress while on active surveillance. For men who follow the process of active surveillance, it is unusual for a cancer to progress so rapidly that we miss the opportunity to offer curative treatment. 

Surgery

The surgery for prostate cancer is known as a radical prostatectomy. It involves removing the entire prostate gland and the nearby seminal vesicles. Lymph nodes may or may not be removed, depending on the aggressiveness of the cancer. Lymph nodes are part of your body's circulatory and immune system. Cancer cells can move in the body through the lymphatic system and end up in nearby lymph nodes. 

Removing and analyzing the lymph nodes can help determine the extent of the cancer. The entire operation usually takes several hours to perform and involves a stay in the hospital.

We offer 4 surgical approaches to prostatectomy. We will explore these options with you in order to provide the one that is best for your situation. Options include the following:

  • Radical retropubic prostatectomy (RRP). The surgeon removes the prostate via a lower abdominal incision from the pubic bone to the navel.
  • Laparoscopic radical prostatectomy (LRP). The surgeon makes several small incisions in the abdomen. A laparoscope (a tiny viewing instrument that also illuminates the surgical site) is inserted into one of the incisions so that the surgeon can identify the prostate and remove it using specialized miniature instruments.
  • Robotic assisted laparoscopic prostatectomy (RALP). This is similar to a laparoscopic radical prostatectomy, but the camera and some of the instruments are held by robotic arms controlled remotely by the surgeon.
  • Radical perineal prostatectomy (RPP). In this case, the surgeon makes an incision below the scrotum.

These surgical options have different advantages and disadvantages. We recommend that you discuss this with us. We will help you choose the option that is right for you.

Surgery Side Effects

Prostatectomy, like all major surgery, has risks that include heart attack, stroke, blood clots in the veins of the leg or pelvis that could migrate to the lungs, infection, hernias, and injury to nearby organs. However, these risks are small in most cases. Long-term complications can include incontinence (being unable to control urination) and impotence (being unable to have erections).

Incontinence affects many men immediately after surgery and is usually diagnosed as "stress incontinence." This generally happens when you exercise, cough, laugh, or sneeze, and it is caused by weakness in the urinary sphincter muscle. 

Men are encouraged to do Kegel exercises, which will help strengthen the pelvis and urinary sphincter, both before and after surgery. During the recovery period, it may be necessary to wear pads or adult undergarments to absorb any leakage. Over time, most men regain urinary control, but there is a small risk of long-term incontinence. If this occurs, we can discuss a number of operations and treatments that are available to prevent incontinence.

The risk of impotence depends on age, quality of erections prior to surgery, and the number of nerves that can be preserved during surgery. Many patients with early-stage cancer are candidates for "nerve-sparing" surgery, which can help avoid erectile dysfunction.

The recovery period for impotence can vary widely but usually takes several months and may take up to 2 years to fully recover. It is important to realize that even when erections return, they are likely to be less rigid than they were before surgery. Also, when erections return, orgasms will feel the same but will not result in ejaculation. This is because the prostate and seminal vesicles that produced the ejaculate fluid have been removed.

A number of treatments can be used after surgery to help with the recovery of erections, including: 

  • Medications 
  • Vacuum erection devices 
  • Penile injections 

If these treatments are not adequate, an operation to implant a penile prosthesis is another option we can discuss.

Radiation Therapy

Radiation therapy for prostate cancer may be considered as the only treatment, combined with hormonal therapy, or given after surgery. Radiation therapy may also be recommended to help manage the pain associated with advanced prostate cancer that has spread to the bones or other areas of the body.

Like other types of therapy for prostate cancer, radiation therapy comes in a range of therapeutic options individualized for your situation. There are 2 major types of radiation therapy:

  • External radiation therapy. External-beam radiation therapy uses high-energy beams delivered through a large machine to a precise location on your body after specific data have been obtained from a planning CT scan. Radiation therapy is usually done on a daily basis on weekdays over 5 to 8 weeks, depending on the diagnosis and stage.
  • Internal radiation therapy. An alternative way of giving radiation is by brachytherapy, in which the radiation is given directly to the tumor site by putting the radioactive material (in the form of seeds or pellets) inside or close to the tumor. This can be done as a permanent (seed) or temporary (high dose radiation, HDR) implant as an outpatient surgical procedure. Brachytherapy treatment can irritate the urethra, bladder, and sometimes, the rectum.

Radiation Therapy Side Effects

There are some common side effects associated with radiation therapy, which can include:

  • Fatigue
  • Bowel discomfort, including diarrhea
  • Rectal pain
  • Blood in the urine or stool
  • Difficult or frequent urination
  • Erectile dysfunction or sexual dysfunction
  • Diarrhea

Side effects are usually related to irritation of the rectum and urinary system. These effects usually go away with time but can persist in a small percentage of patients.

Impotence can be a long-term risk of radiation therapy. Sexual dysfunction may not occur at the time of therapy but may slowly start as the months and years pass after treatment. Regardless of the side effects, we will help you manage their severity.

Hormone Therapy

Hormone therapy, also known as androgen deprivation therapy (ADT), prevents the production and activity of testosterone in the body. Testosterone is the male hormone made in the testicles. Testosterone fuels the growth of prostate cancer cells. The suppression of testosterone slows down the growth of prostate cancer cells. It is mainly used to treat recurrent and advanced prostate cancer. It is also sometimes used along with radiation therapy for earlier-stage disease. 

Hormone therapy alone slows the growth of prostate cancer but cannot cure it. At some point, the prostate cancer cells become resistant to the effects of the androgen deprivation, a condition we sometimes refer to as “hormone refractory” prostate cancer. 

There are 2 ways to administer hormone therapy: surgery or medication. Surgical castration involves the removal of both testicles. While not common, this is a simple outpatient surgical procedure with minimal complications and quick recovery. It provides continuous and permanent removal of testosterone from the body.   

Medical ADT most commonly uses drugs known as LHRH agonists, such as leuprolide (Lupron) and goserelin (Zoladex), which are given by injection. They work by using a complex feedback area in a part of the brain (the hypothalamus) that controls how much testosterone is produced by the testicles. 

The result of the LHRH agonists is to shut down testosterone production by the testicles. This reduces the level of testosterone in the body close to zero, the same effect as removing the testicles, but without surgery. These medications can be administered in a variety of ways that allow for either continuous or intermittent suppression.   

Antiandrogens are another type of drug that limit the activity of testosterone in the body. These drugs include flutamide, bicalutamide, and nilutamide. They are rarely used alone but are most often used along with the LHRH agonists.

Hormone Therapy Side Effects

In general, since hormone therapy circulates throughout the entire body, it can also affect other normal cells in your body. The side effects of hormone therapy can include:

  • Fatigue
  • Osteoporosis (thinning of the bones)
  • Impotence
  • Hot flashes
  • Loss of libido
  • Increased body fat
  • Increased risk of diabetes
  • Increased risk of heart disease

The effectiveness of hormone therapy may wear off after a few years, so we will continue to monitor your progress during this time.

Additional References:

Clinical Trials

We’re always looking for new and better ways to treat prostate cancer. Clinical trials are research studies that test new treatments and procedures. We can talk about available clinical trials that may be right for you.

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