Prostate Cancer Treatment
The treatment of prostate cancer is varied and involves a fairly complex decision making process. The treatment options for localized disease vary from what we call active surveillance, which involves close monitoring or observation of the cancer, surgical removal of the prostate, ablation of the cancer with tools such as cryotherapy, external radiation and radiation seed implantation. For patients with more advanced disease, androgen therapy remains the backbone of treatment. However, oncologists are increasingly utilizing chemotherapy, cancer vaccines and immunotherapy.
This treatment option is ideal for patients with a very low or low likelihood that their cancer will spread. This management option requires close monitoring through repeated exams, PSA measurements, biopsies and even MRI scans. If there are any signs of disease progression, active treatment will begin.
Radical Prostatectomy involves the surgical removal of the prostate. There are multiple techniques that include:
- Open Radical Retropubic Prostatectomy (small incision is made in the mid to lower abdomen)
- Open Radical Perineal Prostatectomy (small incision below the scrotum and above the anus)
- Robotic Prostatectomy. Robotic surgery takes advantage of advanced improved optics and a wider range of motion, leading to less blood loss and a potentially easier convalescence. The robotic procedures last about two to four hours, require a one to two day hospitalization and six to eight week recovery period.
Radiation therapy utilizes high energy x-rays to damage the DNA of cancer cells, inducing tumor cell death.
- External beam radiation uses various image guided and intensity modulated techniques to deliver radiation. The daily radiation treatments are typically 15 minutes in duration, five days a week (Monday through Friday) for up to eight weeks. CT simulation ensures very accurate targeting of the cancer.
- Brachytherapy utilizes radioactive seeds placed directly into the prostate during a one to two hour outpatient procedure. It is sometimes combined with external beam radiation.
- Proton beam radiation refers to a type of external beam radiation using a heavy charged particle that can deposit energy over a short distance. This is designed to have less toxicity to the patient.
Cryosurgery is a technique that involves the controlled freezing of cancer. This procedure is performed under an anesthetic in an outpatient setting. Needles are directly inserted into the prostate under image guidance, which are attached to cooled gas that lowers the temperature of the probe to below freezing.
Hormone therapy involves the elimination of testosterone production or it's blockade at the receptor level. The loss of testosterone stimulation inhibits the growth and proliferation of cancer cells. It is typically used in more advanced cases or with metastatic disease. Though not curative, this treatment can control the cancer for extended periods of time. Occasionally surgical castration (removal of the testicles) is used to rapidly drop testosterone levels.
Immunotherapy may be used for men with advanced prostate cancer in whom hormone therapy has failed. It typically includes cancer vaccines and other biologic approaches to either augment the immune system or inhibit immune suppressors.
Chemotherapy utilizes powerful chemicals to directly kill cancer cells. Various chemotherapy agents have been used in more advanced prostate cancer cells to decrease the burden of disease, reduce symptoms and prolong life.