Treatment Options for Prostate Cancer

Treatment Options

Many factors affect choosing a treatment or treatments, such as stage of the cancer, age of the patient and overall health. Talk to your doctor about the best possible treatment options for your specific case.

Surgery

Surgery is the most common treatment, particularly in early-stage prostate cancers. Part or all of the prostate may be removed. In certain high-risk prostate cancer patients (based on their clinical stage, Gleason score and their PSA), doctors do an evaluation of pelvic nodes to check whether the cancer has spread to the lymph nodes. The lymph nodes are located immediately around the prostate gland and are dissected and sent to pathology for evaluation to rule out metastatic cancer.

Surgeons can perform minimally invasive radical prostatectomies (removal of the prostate) by using the da Vinci robotic surgical system. The da Vinci’s robotic arms are inserted into four small holes about the size of a pencil. Through a tiny camera placed in the body, surgeons have a magnified 3-D view of the area being operated on, which is magnified up to ten times more than what the surgeon would see with the naked eye. The surgeon “operates” from a console about ten feet away from the patient by using master controls that act as the surgeon’s “hands” for the procedure. While grasping the controls, the surgeon’s movements are translated into real movement by the robotic arms inside the patient; the robotic arms are designed to minimize tissue damage.

Patients benefit from robotic surgery in the form of reduced pain and trauma to the body, less blood loss, less postoperative pain, less risk of infection, shorter hospital stays, faster recoveries and less scarring. In addition, patients tend to experience less incontinence and impotence after the minimally invasive procedure using the da Vinci.

During a radical retropubic prostatectomy (done by making an incision in the abdomen) or radical perineal prostatectomy (making an incision between the scrotum and anus), the surgeon can remove the entire prostate, including surrounding lymph nodes. Loss of bladder control and impotence are frequent side effects of prostate surgery; however, GW has expertise in nerve-sparing prostate surgery. Results with preserving continence and erectile function compare favorably with other academic centers performing the operation.

Non-Surgical Treatments

If cancer has spread to nearby lymph nodes, surgery may not be a practical option.

External beam radiation therapy kills cancer cells with intense X-rays aimed only at the cancerous growth. With advances in technology, particular medical equipment can emit radiation from outside the patient’s body, or radioactive materials can be placed internally to the targeted area. Patients may receive one or both forms of radiotherapy, depending on the size of the cancer.

Brachytherapy is the most advanced method of radioactive seed implantation. This method uses the latest advances in computer calculation of internal seed placement for maximal effect and minimal side effects. The dose of each seed is customized at the time of surgery to conform to the size of the individual prostate gland.

In general, side effects of radiation therapy include extreme fatigue, though physicians recommend staying active throughout treatment. Patients may also experience painful or frequent urination, diarrhea or impotence. External beam radiation often causes hair loss and skin irritations in the area of treatment. Internal radiation, meanwhile, is less likely to affect erectile functioning but slightly more likely to cause temporary incontinence.

Hormone therapy can prevent prostate cancer cells from getting the male hormones they need to grow, even if they have spread to other parts of the body. Although it won't cure prostate cancer, hormone therapy can control it.

In cryotherapy, the prostate is frozen rapidly to kill cancer cells. This procedure is performed by placing probes into the prostate while the patient is under anesthesia. Survival data suggest that cryotherapy for localized prostate cancer is at least equal to radiation therapy with either seed implantation or external beam.