Prostate Cancer

Anatomy | Causes-Risks | Symptoms | Cancer Grading - Staging | Diagnosis | Treatment

Treatment

Choosing an appropriate treatment for prostate cancer is a complex process and involves many factors the most important of which includes the stage of the cancer. Surgery, radiation, cryoablation, and hormone therapy are the most common treatments for prostate cancer. Chemotherapy may be used in some cases, and watchful waiting, though not actually a treatment, may be an option for some men.

WATCHFUL WAITING

Watchful waiting is a reasonable alternative to surgery for elderly patients, those in poor health, or those with early cancer. Untreated prostate cancer may take years to reach a problematic stage. During this time, the physician monitors and evaluates the patient's condition. Any marked or sudden progression of the disease may signal the need for more aggressive treatment. 

SURGERY

Radical prostatectomy: In a radical prostatectomy the entire prostate gland and some tissue around it is removed. There are three basic surgical approaches to radical prostatectomy which include:

• Radical Retropubic Prostatectomy
  • Performed through an incision over the lower abdomen
  • Pelvic lymph nodes can be removed (if necessary)
  • Nerves can be spared to facilitate preservation of sexual function
• Radical Perineal Prostatectomy
  • Performed through an incision over the perineum (area between scrotum and anus)
• Robotic Radical Prostatectomy 
  • Minimally invasive procedure
  • Performed using the da Vinci^® Surgical System and fine laparoscopic instrumentation inserted through 5 to 6 small 1-cm incisions across the mid abdomen
  • Shorter hospital stay (1 day or less)
  • Less post operative pain and discomfort
  • Less blood loss and need for transfusion
  • Enhanced ability to spare nerves for potency
  • Precise urethrovesical anastomosis (excellent urinary control)
  • Earlier catheter removal (5 to 7 days)
  • Faster recovery and return to normal activity ( 10 to 14 days

The main side effects of radical prostatectomy are lack of bladder control (incontinence) and not being able to get an erection (impotence). Incontinence is rare with occurrence in less 1-5 percent of all surgical cases. However, when it does occur, there are procedures that can solve the problem. Impotence, if experienced post-surgery, can also be treated by a variety of medications and/or technical devices vacuum erection devices and penile prostheses.

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RADIATION THERAPY

Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation is sometimes used to treat low-grade cancer that is still confined within the prostate gland or that has only spread to nearby tissue. If the disease is more advanced, radiation may be used to reduce the size of the tumor and to provide relief from present and future symptoms. 
Two main types of radiation therapy are used: external beam radiation and brachytherapy (internal radiation). Both appear to be good methods of treating prostate cancer, although there is more long-term information about results of treatment with external beam radiation. 

Two main types of radiation therapy are used: external beam radiation and brachytherapy (internal radiation). Both appear to be good methods of treating prostate cancer, although there is more long-term information about results of treatment with external beam radiation.

• External Beam Radiation Therapy (EBRT): External beam radiation is focused on the prostate gland from a source outside the body. It is much like getting a diagnostic x-ray but for a longer time. Before treatments start, imaging studies such as MRIs, CT scans, or plain x-rays of the pelvis are done to find the exact location of the prostate gland. Treatments are usually given 5 days per week on an outpatient center over a period of 7 or 8 weeks. Each treatment lasts only a few minutes and is painless.
  
• Brachytherapy: Brachytherapy involves the insertion of a radioactive material, commonly referred to as a source, into the prostate. There are two approaches to brachytherapy for prostate cancer: low-dose rate (LDR) and high-dose rate (HDR). Prostate brachytherapy is most commonly performed using the LDR technique. With LDR brachytherapy, the seeds are permanently placed into the prostate. The radiation is given off gradually over a period of months. HDR brachytherapy involves the temporary placement of a highly radioactive source into the prostate. The radiation treatment is given off over a period of minutes and typically repeated two or three times over the course of several days. Both LDR and HDR brachytherapy may be combined with EBRT.
  
  Common side effects of radiation therapy for prostate cancer include increased urinary frequency; mild burning with urination; weakened urinary stream; urinary retention; bowel irritability; mild irritation of the skin around the rectum; lower blood counts; and fatigue. Relatively rare complications include significant rectal bleeding, bladder irritability and urethral stricture. The loss of sexual function is also a relatively common side effect of radiation. 

CRYOABLATION 

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HORMONE THERAPY 

The following types of hormonal therapy may be used in prostate cancer:

• Orchiectomy or Surgical Castration is the surgical removal of the testes, which are the organs that produce male hormones
• Drugs that prevent the production or block the action of testosterone and other male hormones, called androgens. Two classes of drugs most commonly used as hormonal therapy in prostate cancer include: 
  • LHRH analog(s) (luteinizing hormone-releasing hormone analogs) or medical castration — class of drugs which prevent testosterone production by the testes.
  • Nonsteroidal antiandrogens (also called antiandrogens) — class of drugs which block the action of testosterone at the prostate. 

Hormonal therapy is most commonly used to treat cancer that has spread (metastasized) outside the prostate and pelvic area (Stages N+ and M+). 

In patients with early-stage cancer (Stage T1-T2), hormonal therapy may be used in combination with radiation therapy or prostatectomy. It may also be combined with radiation therapy or prostatectomy in advanced stages of cancer when the disease has spread locally beyond the prostate (Stages T3-T4).

Potential side effects associated with hormonal therapy include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, swollen and tender breasts and erectile dysfunction.

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CHEMOTHERAPY 

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