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High-dose brachytherapy may be offered for higher risk cancers, but this is not widely available.‘Treatment is rapid, taking just two days,’ explains Professor Neal.Because the radiation doesn’t travel very far in the body, the healthy tissue around the prostate gland gets a much smaller dose of radiation and so may cause less damage to bladder and urethra resulting in fewer incontinence problems.Low-risk, early-stage prostate cancer that is contained within the prostate. This measures the aggressiveness of the cancer from a tissue sample.A score of six and under is the least aggressive cancer; seven indicates a middle-ranking cancer; eight and above is the most aggressive. These include a prostate specific antigen test to detect a protein linked to prostate cancer (rising levels could indicate the cancer has become more serious), digital rectal examinations, magnetic resonance imaging (MRI) scanning and biopsies.There are two methods — by hand or using a Da Vinci robot (a relatively new technique).The surgeon makes five or six small cuts in the abdomen and inserts a camera through a tube that magnifies everything ten-fold.
(The prostate surrounds the urethra, the tube that delivers urine out of the body, like a doughnut.) ‘Some doctors say this has a lower risk of impotence, but the evidence is not there,’ says Professor Neal.Men with smaller and localised tumours that are low-medium risk (Gleason grade seven).Not suitable for those with large prostates or men with urinary problems, as it will make the problem worse.Pretty much everyone is impotent straight after.’‘It’s fair to say that a man in his 50s has a better chance of retaining function than a man in his 70s,’ adds Professor David Gillatt, director of the Bristol Urological Institute.
Nerve-sparing prostate surgery is where the surgeon tries to avoid damaging the two nearby bundles of nerves that control erections, explains Mr Anderson.
It may be possible if the cancer has not spread too far.