Prostate Cancer Treatment
Surgery remains the primary treatment when the cancer is confined to the prostate.
Types of Surgery
Radical Retropublic Prostatectomy (RRP)
The gold standard for prostate cancer surgery. This involves an open approach through a 5-inch incision in the lower abdomen (belly) through which the prostate and lymph nodes are removed. This approach affords excellent exposure or vision for removing the prostate, sparing the nerves that provide erections, and reconstructing the urinary channel to assure return of urinary control.
Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP)
The latest advance in prostate cancer surgery is performed with the daVinci® robotic surgery system at St. Vincent Hospital. This approach involves removal of the prostate through five or six small incisions or cuts in the belly using small instruments and a camera. The use of the camera, which magnifies the internal organs 12 times, along with the specialized surgical instruments, allow for a very precise operation. It allows the removal of the prostate while selectively preserving the muscles that help with urinary control and the nerves that help with erectile function. With any of the surgical techniques, the possible side effects are incontinence and impotence.
If the cancer has already broken out of the prostate (metastasized), treatment options include hormone treatment and/or chemotherapy.
- Hormone Therapy - typically reserved for patients whose cancer has already spread to the lymph nodes, bones, or both. Hormone therapy is used to decrease the production of testosterone, which temporarily slows the cancer cell growth. It does not cure prostate cancer. This therapy typically involves shots every four to six months for the rest of the patient’s life. Hormone therapy is also now being used in combination with radiation as a radiosensitizer to improve the cure rate in higher risk patients.
- Chemotherapy - typically reserved for patients whose prostate cancer has already become metastatic to other sites in the body. Generally, the patient has been on hormone therapy and now the cancer is progressing through the hormone treatment, called hormone refractory prostate cancer.
Radiation is often used to treat prostate cancer, especially in men over 70. It is administered either by traditional external beam radiation (IMRT, IGRT), implantation of radioactive seeds (brachytherapy), or a combination of interstitial and external therapy (HDR).
St. Vincent Regional Cancer Center was one of the first in the state to provide permanent prostate seed implants. “Permanent seed” means radioactive seeds placed into the prostate through very thin needles so the radiation can destroy the cancer cells.
High Dose Rate (HDR) Brachytherapy
Similar to seed brachytherapy, needles are placed in the prostate using ultrasound for guidance. The needles are then connected to a high dose radiation source to provide a single seed of radiation. Patients generally receive 2 treatments; each lasting about 20-30 minutes.
LDR Prostate Seed Implantation
LDR prostate see implantation does not require a surgical incision. Instead, seeds—smaller than grains of rice—are contained in thin needles, which are passed into the prostate gland through the skin. The tiny seeds, which are radioactive, are permanently implanted in the prostate where they give off low-level radiation continuously for approximately one to two years. Most of the radiation is released between two to six months after the implant. Relatively little radiation reaches the adjacent cancer-free organs.
These advances in treatment, allowing for higher doses and extreme accuracy, have led to far fewer side effects and significantly fewer risks when compared with traditional radiation therapy. With these advances, it is rare for men receiving radiation therapy as their primary treatment to suffer total incontinence or severe rectal problems.
The radiation oncologist will recommend which types of treatments are best for each patient’s individual care.
Cryotherapy involves the freezing of the prostate. It is a minimally invasive approach performed on an outpatient basis with minimal pain and a short recovery. It is a single “once-and-done” treatment for prostate cancer, but a good treatment option only for men who are already impotent, as it carries a greater then 95 percent rate of impotence.
Active Surveillance involves simply observing prostate cancer once it is diagnosed and not actively treating it. This is an approach most often used in men with a life expectancy of less than 10 years or older men with very slow growing tumors, as well as select men with early stage disease. Now supported by numerous published medical journal articles as well as new guidelines from the National Comprehensive Cancer Network (NCCN), our team of expert clinicians were early leaders in this less invasive, yet safe alternative to immediately pursuing aggressive treatment with its associated side effects.