Treatment of Prostate Cancer
The three options for early-stage/low-risk prostate cancer are surgery, radiation therapy and active surveillance, also known as expectant management or watchful waiting.
- Medical Treatment: The patient's age, stage of the disease, lifestyle factors and overall health are considered in determining the course of treatment taken for prostate cancer. Elderly patients with minor symptoms, early stage cancer, or coexisting illness may be treated conservatively.
- Watchful waiting (also called active surveillance) is a logical course of action for patients who are elderly, who are in poor health, or who have low-risk, early stage cancer. Untreated prostate cancer may take years to become problematic. Your urologist should carefully monitor this condition for any marked or sudden progression, which may signal the need for more aggressive treatment.
- Hormone therapy for prostate cancer involves removing, blocking, or adding hormones to fight prostate cancer. Drugs are given to block the production of testosterone, which prostate cancer cells use to grow. Although effective such treatment can have debilitating side effects such as hot flashes, depleted bone density, and weight gain.
- Treatment for bone metastasis when prostate cancer causes bone metastases, bone tissue breaks down, which releases calcium into the bloodstream. In addition to treatment to block androgen, an IV bisphosphonate zoledronic acid is used to stabilize bone mineral density in this setting.
Brachytherapy (radioactive seed implantation) This procedure, which has been used for over a century, involves placing radioactive seeds directly in the prostate. The radiation given off is tightly localized.
The radioactive seeds are about the size of a grain of rice, and give off radiation that travels only a few millimeters to kill nearby cancer cells. With permanent implants the radioactivity of the seeds decays with time while the actual seeds permanently stay within the treatment area.
Tests before the brachytherapy procedure may include blood tests, an electrocardiogram (EKG), and chest x-rays. The results are used by anesthesiologists to determine what kind of anesthesia to use during the brachytherapy procedure.
An ultrasound probe is inserted into the rectum, which will show the prostate gland on a television monitor, to aid the doctor in placement of the seeds. The seeds are then implanted into the prostate through very thin needles. Depending on different variables, between 50 and 100 seeds are used. The needles are inserted into the skin between the scrotum and rectum and are guided to the right place to most effectively treat the cancer. At the end of the procedure, a catheter will be placed in your bladder to help you pass urine during recovery.
External radiation treatment (XRT) is the treatment of prostate cancer with high energy beams, from x-rays or other sources, directed at a target inside the body. The linear accelerator moves around you to deliver radiation from several angles. The linear accelerator can be adjusted so that it delivers the precise dose of radiation.
Radiation damages both cancer cells and normal cells, interfering with their ability to divide and grow. However, scheduled breaks between radiation sessions allow normal cells a chance to repair while not giving cancer cells enough time to recover. You typically receive external beam radiation on an outpatient basis five days a week over a period of at least two to 10 weeks. Expect each treatment session to last approximately 10 minutes to 30 minutes. In some cases, a single treatment may be used to help relieve pain or other symptoms associated with more advanced cancers.
Surgical Treatment
Radical prostatectomy is an operation to remove the entire prostate and any nearby tissue that may contain cancer. It can be done as open surgery through an incision (cut) in the belly, or as laparoscopic surgery, or robotic surgery.
Laparoscopic radical prostatectomy surgery is done through several very small incisions in the abdomen utilizing a tiny camera and special instruments to remove the prostate.
Robotic surgery is a new category of minimally invasive surgery performed with the da Vinci® Surgical System. Robotic surgery is a form of laparoscopic surgery that utilizes robotic arms and instruments to facilitate dissection in a more precise manner than traditional laparoscopic surgery.
What is the da Vinci System? www.davincisurgery.com
The da Vinci System is a sophisticated robotic platform designed to expand the surgeon's capabilities.
Patients benefit from the potential for significantly less pain, a shorter hospital stay, and faster return to normal daily activities – as well as the potential for better clinical outcomes. It is important to know that surgery with da Vinci does not place a robot at the controls, your surgeon is controlling every aspect of the surgery. At the same time, state-of-the-art robotic and computer technologies scale, filter, and flawlessly interpret your surgeons hand movements into the precise micro-movements of the da Vinci instruments.
At Premier Medical Group Urology Division we continue to bring the latest technology to our patients such as the da Vinci robotic surgical system. Dr. Naeem Rahman specializes in the robotic surgical system, and sees patients in Kingston, Fishkill and Poughkeepsie. To learn more robotic surgery and view Dr. Rahman's video on the subject, click here.
Cryosurgery (cryoablation): This minimally invasive outpatient procedure, offered at Premier Medical Group Urology Division, destroys cancer cells by rapidly freezing and thawing cancerous tissue. It is recommended for patients who cannot tolerate surgery or radiation, have prostate-confined tumors (stage T3 or lower), do not respond to radiation (both external-beam and brachytherapy), and are elderly. It is increasingly being used for patients who fail radiation therapy, as it offers an effective treatment for those cancers.
High intensity focused ultrasound (HIFU) is currently undergoing clinical trials in the United States. This is a noninvasive treatment that uses precision-focused ultrasound waves to heat and destroy (ablate) targeted prostatic tissue without affecting healthy surrounding tissue. It has been shown to effectively treat localized prostate cancer as well as benign prostatic hyperplasia (BPH). To date, the FDA has not approved this treatment in the United States.
Laparoscopic radical prostatectomy: This involves several tiny incisions instead of one large one. The surgeon places a thin tube with a video camera (laparoscope) inside one of the cuts. He can see inside your belly during the procedure. Due to the advantages of robotic surgery, laparoscopic prostatectomy is being performed less and less.
After the prostate has been removed, your surgeon will insert a catheter to allow the urethra to heal with the bladder. Drains are placed around the site and then the incision is closed. The catheter can usually be removed in 6-7 days after robotic surgery, 10-14 days for open surgery. Dressings should be kept on the wounds until they have completely dried up.