Prostate Cancer Treatments

Prostate Cancer Treatments: Learn How to Become Prostate Cancer Free
Content contributed by R. Alex Hsi, M.D.
Peninsula Cancer Center

Prostate Cancer Treatments: Which is Best for Treating your Cancer?

Which of the Prostate Cancer Treatments Is Best For You?

The treatment of prostate cancer depends upon many factors. The type of cancer, whether or not the cancer has spread (metastasized), a patient’s age, general health status, and prior prostate treatments the patient may have undergone. There are three standard therapies for men with organ-confined prostate cancer: Active Surveillance, Surgery and Radiation Therapy.

Watchful Waiting or Active Surveillance?

ACTIVE SURVEILLANCE
In select patients with prostate cancer, the best choice may be active surveillance. Active surveillance also is called “watchful waiting.” Of the Prostate Cancer Treatments, Active surveillance may be recommended only if a cancer is not causing any symptoms and is expected to grow very slowly. This approach is sometimes suited for men who are older or have other serious health problems. Because some prostate cancers spread very slowly, older men who have the disease may never require treatment. Other men choose active surveillance because they feel the side effects of treatment outweigh the benefits. The cancer is regularly and carefully monitored with PSA, clinical evaluation and intermittent prostate biopsies to ensure that the cancer is not becoming more aggressive. If progression of the cancer is evident, active treatment can be started.
Active Surveillance

Surgery?

Surgical treatment for prostate cancer involves removing the entire prostate as well as the seminal vesicles, a procedure called radical prostatectomy. There are two prostate cancer treatments classified as radical prostatectomy, open radical retropubic prostatectomy and laparoscopic radical prostatectomy.


Prostate Cancer Prostatectomy: RRP or RALP?
Radical Retropubic Prostatectomy (RRP) The surgeon makes a skin incision in the lower abdomen. The prostate is removed from both the bladder and the urethra. After the prostate is removed, the bladder is connected to the urethra with suture. Takes 2-3 hours to perform with a hospital stay of 2-3 days.

Prostate Cancer Treatments: Prostatectomy DaVinci Surgical System
Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) Minimally invasive surgical technique to remove the prostate and seminal vesicles. The surgeon performs the procedure through five 1-cm incisions spread in the shape of a fan across the lower abdomen. The surgeon performs the procedure using a robotic surgical assist device called the daVinci® Surgical System. Takes 2.5-3.5 hours to perform with a hospital stay of 24-48 hours.

Radiation Therapy ?

Radiation therapy is either a non-invasive, or minimally invasive treatment for prostate cancer that uses x-rays or gamma-rays to eradicate prostate cancer cells. Prostate cancer treatments have several forms of radiation therapy that may be recommended. Each patient receives a customized treatment plan depending on the nature of the cancer, the patient’s unique symptoms and overall health.

External Beam Radiation Delivered using an x-ray machine called a linear accelerator. Treatment is delivered on a daily basis, 5 days per week, for up to 8 or 9 weeks. Listed below are the four primary techniques.
o Intensity Modulated Radiation Therapy (IMRT)
o Volumetric Arc Therapy (VMAT)
o Image Guided Radiation Therapy (IGRT)
o Proton Beam Radiation Therapy – Proton beam radiation therapy utilizes particle radiation (protons) instead of electromagnetic (photon or x-ray) radiation to destroy tumor cells

Prostate Cancer Treatments: Prostate Cancer External Beam Radiation
Prostate Seed Brachytherapy The implantation of small radioactive pellets, or “seeds,” into the prostate. The radioactive seeds deliver high doses of radiation to a very confined region, making it possible to deliver a higher dose of radiation to tumor cells within the prostate. Seed placement is determined, by use of previous ultrasound to map, or use of ultrasound image during the actual procedure to place radioactive seeds.
Prostate Cancer Treatments: Prostate Cancer Radiation
High Dose Rate Radiation High dose rate (HDR) brachytherapy is a procedure similar to seed brachytherapy, but instead of permanently placing radioactive seeds into the prostate, catheters are attached to empty needles placed into the prostate and a highly radioactive source is placed temporarily (for approximately 5-15 minutes) into the needles to deliver radiation to the prostate. Prostate Cancer Treatments: BrachyTherapy

Other Prostate Cancer Treatments: CRYO, HIFU, CHEMO, or Hormone Therapy?

Cryotherapy Cryotherapy (also called cryoablation or cryosurgery) can be used to treat localized prostate cancer by freezing the cancerous cells. This procedure is performed under general or spinal anesthesia and may be performed as an outpatient or may require an overnight stay. The probes are placed through skin incisions located between the anus and scrotum. Guidance and monitoring of therapy is performed using transrectal ultrasound.
HIFU HIFU or High Intensity Focus Ultrasound procedure may be an option for men diagnosed with organ-confined prostate cancer. During the procedure, precisely focused ultrasound waves raise the temperature of the targeted prostate tissue to 195 degrees Fahrenheit in 2-3 seconds.
Chemotherapy Chemotherapy utilizes drugs injected intravenously or by mouth to stop the growth of cancer cells. It is usually used in cases where prostate cancer has spread outside the gland (metastasized) or is resistant to androgen deprivation therapy. Chemotherapy is given in cycles in which the drug is given over a few days to week followed by a rest period to allow the body time to recover. Each cycle typically lasts several weeks to a month.
ADT or Hormone Therapy Hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy. Androgens (testosterone and dihydrotestosterone) are produced mainly in the testicles and stimulate prostate cancer cells to grow. While not curing prostate cancer, lowering androgen levels often stops or significantly slows the growth of prostate cancer cells. Reducing androgen levels is accomplished mainly by oral or injected medications, called chemical castration. This can also be achieved by removal of the testicles (castration).

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