Prostate Cancer Treatment

Radiation Therapy for Prostate Cancer

Radiation therapy is commonly used along with other treatments for prostate cancer to ensure maximum survival rates. There are two types of this treatment, both external and internal. Side effects can be serious but may subside in time. Compared to surgery, radiation therapy alone generally works just about as well.

The two types of radiation treatment are external beam, and brachytherapy. External beam involves a high-intensity X-ray aimed directly at the prostate cancer, which kills the cancer cells. Brachytherapy is the process of planting small rice-sized “seeds” of radioactive material directly into the prostate gland, irradiating the cancer cells from within. Brachytherapy is generally used with lower risk patients and can be performed on an outpatient basis, being less invasive than other forms of treatment.

So how effective is it?

Radiation therapy is generally considered to be just as effective as surgical removal of the entire prostate gland, although in many cases radiation treatment is used in addition to other forms of therapy, such as surgery and hormonal therapy. Various combinations of external beam, brachytherapy, hormonal, and surgery may be put together by the doctor depending on the specific requirements of the patient, such as age, other illness, prostate cancer advancement, and so on.

Side Effects

The most common side effects of radiation therapy include impotence and problems controlling urinary urges. Some patients have also experienced rectal bleeding and diarrhea, due to inflammation of the lower intestines from the radiation exposure. In many of those with side effects, the symptoms will resolve in time after the treatment is over.

Radiation treatment is usually chosen by the doctor based on the specific requirements of the patient. In intermediate cases of prostate cancer, the doctor may choose surgery in addition to radiation therapy. This will entirely depend on the cancer and needs of the patient.

Various Prostate Cancer Surgery Options

When cancer is confined to the prostate gland, one of the most common forms of treatment is surgical removal of the entire prostate, known as a radical prostatectomy. There are several different ways this is performed, including the minimally invasive laparoscopic version which involves only a few small incisions in the abdomen. The major problem with having this surgery are the side effects that can result in serious quality-of-life issues.

There are a few ways this procedure can be performed.

Side Effects

This is quite possibly one of the biggest drawbacks to this treatment. The prostate cancer is completely removed, but if nerves are cut in the process impotence can result. Some men also experience problems controlling their bladder. These are both serious issues that must be taken into account by both patient and doctor. Some experienced surgeons can perform what’s called “nerve-sparing” prostatectomy, an attempt to cut around the nerves that affect erections, but this is only possible of the tumor is small and only localized to the prostate gland.

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Is Watchful Waiting a Viable Treatment Option?

It’s hard to believe that this could be a legitimate treatment option for prostate cancer, but watchful waiting or “active surveillance” is sometimes considered by doctors treating their patients. It is what it sounds like: doing nothing but monitoring the cancerous prostate gland carefully for signs of matastisizing or an increase in cancer cells. While not a true therapy per se, watchful waiting can be useful in certain situations, such as older gentlemen and men with a low PSA count.

Since prostate cancer is such a slow growing disease, watchful waiting can be a safe possibility if conditions warrant it. Much of the time it is recommended to the more elderly patients, whose natural lifespan is expected to be shorter than the length of time in which the disease would be able to spread. Since more invasive treatment can affect quality of life, the doctor will make a careful determination if this form of “treatment” is a good fit for the patient’s cancer.

On occasion, watchful waiting, may also be used on those who have very low PSA levels and Gleason scores. Since these are all indications that the prostate cancer MAY be slow and non-aggressive, surgery and other more radical treatments can be effectively put off for a few years as long as the doctor continues to regularly monitor the cancer. Keep in mind, however, that if the cancer begins to grow, aggressive treatment may need to begin soon.

In general, watchful waiting is good for those who are extremely elderly, or with other debilitating diseases. Most men are going to want to choose a more permanent treatment for their prostate cancer, as this will probably be the eventual outcome anyway.

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Minimally Invasive Surgery for Prostate Cancer

Men who require surgery on their prostate gland have more choices today, thanks to a process called Minimally Invasive Surgery, according to Health Notes, a publication from the Washington University School of Medicine in St. Louis.

An October newsletter titled Health Notes from Washington University physicians said urologists lead the way in laparoscopic prostate surgery, which benefits the patient over traditional open surgery.

Minimally invasive surgery, sometimes called laparoscopic surgery, is performed through multiple small incisions, one-quarter to one-fourth inches long, using specially designed surgical instruments and viewed through a laparoscope, or surgical telescope. These tiny incisions mean shorter hospital stay, less pain, less bleeding and a much quicker recovery.

He said that even with radical prostatectomy, when the entire prostate gland is removed, laparoscopic surgery is as safe and effective as any surgical procedure. Also, it is the method preferred for men who are overweight.

The report said that nerve and tissue-sparing methods have greatly reduced the after-effects of such surgery, which may include urinary incontinence and erectile dysfunction. Patients can go back to work or resume full activity in two to three weeks.

The minimally invasive surgery process is performed through small incisions, using specialized instruments: miniature cameras with microscopes and tiny fiber optic flashlights. Because the surgeon views the inside of the body through a camera, the aim is accurate and surrounding organs are less affected. With the less-invasive technique, patients recover faster, have less bleeding, and less need for pain medication.

Thus, the report said, a patient can opt for minimally invasive surgery to get back to normal activities quicker, with less pain and scarring. It was said that highly trained surgeons with years of experience make a significant difference in the successful outcome of these surgeries.

The Washington University Institute for Minimally Invasive Surgery is the largest group of minimally invasive surgeons in America. The newsletter said they lead the way in laparoscopic techniques, especially for complex cases like prostate cancer.

Moreover, the report said, if your doctor recommends surgery for problems with the digestive tract, heart, hernia, gallbladder, spine, colon, as well as the prostate, the patient should consider minimally invasive surgery. He then should ask his doctor to refer him to a Washington University physician. Patients can call TOP-DOCS at 314-867-3627 for more information.

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3 New Treatments for Prostate Cancer

Three new treatments for prostate cancer, a vaccine, cryosurgery and a clinical experiment, look hopeful in the view of the physicians who performed them.

The new vaccine, named Provenge, was tried during a study of 127 men with advanced prostate cancer. Of the 127, those who were given the vaccine lived 4 ½ months longer that the men who were given a placebo. The physician who performed the study, Dr. Eric Small, said of the group that 34 percent of the men who received the vaccine were still living after three years. Of those who did not receive the vaccine, only 11 percent survived.

Small said the treatment trains the patient’s immune system to fight tumors and, though it’s called a vaccine, it treats prostate cancer instead of preventing it. The phrase cancer vaccine, he said, describes a situation where a patient’s immune system immediately recognizes cancer cells and destroys them without doing any harm to normal cells.

Focal cryosurgery was performed on 20 men from 58 to 70 years old who suffered from prostate cancer. Nicknamed male lumpectomy, focal cryosurgery looks promising as a primary treatment for prostate cancer, doctors say. Even better, they added, there is little to no risk of a man becoming impotent or suffering from urinary incontinence, that is, enduring a too-frequent urge to urinate night and day.

The report on cryosurgery describes the procedure this way: the prostate tumor is frozen with a blast of argon gas, which destroys it. Best of all, the report said, it kills the malignant cells but saves the healthy tissue, as it does for the prostate gland.

After the 20 men in the study underwent the cryosurgery procedure, it showed that 19 of them had no evidence of cancer in later examinations between two and eight years. The physician said the procedure is competitive to normal radiation and prostatectomy surgery that prostate cancer patients endure, and may even be better. Also, he added, 80 percent of the men in the study avoided impotence and incontinence: two very common effects of traditional prostate cancer treatments.

Though it is not conclusive yet, a gene therapy for prostate cancer called AD5-TRAIL, has undergone a Phase I study to test whether the dosage can safely be given to patients. Thomas Griffith, Ph.D, an associate professor in the University of Illinois Department of Urology, and Dr. Richard Williams, the Rubin H. Flocks Chair in Urology, who also is professor in the university’s urology department, performed the clinical study.

The two men injected the cancerous prostates of three willing patients. After a 10-day waiting period, the prostates were removed and currently are undergoing an evaluation as to the effects. Williams said the preliminary results look promising because the three patients underwent the treatment without any detected side effects. “We hope the results will permit us to proceed with the research process,” he said.

The future looks hopeful for cancer patients as new and emerging technologies improve effectiveness of current treatments and new procedures are developed. Gene therapy may eventually be the most useful as it attacks the problem at it’s source, although perfection is still years away. Men who are diagnosed with cancer however will soon have a multitude of alternatives to the somewhat less than perfect radiation and surgeries available today.

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How Prostate Staging Helps Your Doctor Evaluate Treatment Options

To help evaluate possible treatments, most cancers are staged by a doctor, or put into a category describing how far they have spread. While prostate cancer is generally a slower-growing disease, once it has spread outside the prostate, known as metastasized cancer, it quickly becomes dangerous. First it attacks the local lymph nodes. Then it spreads to other lymph nodes throughout the body, and finally invades major organs. After it spreads, the first major organ it attacks is usually the bones. The most common scale used for staging is the TNM scale. T stands for tumor, N stands for lymph nodes, and M stands for metastasize. Through a combination of various tests, the doctor will assess the spread and label it accordingly:

From T1, the cancer is confined to the prostate, through T4, the cancer has spread outside the prostate. From N0, the cancer has not spread to the local lymph nodes, through N1, the cancer has spread to the local lymph nodes. From M0, the cancer has not spread to distant locations, through M1, the cancer has spread to distant bodily locations.

Along with staging, the cancer can also be graded. Cancer cells can often mimic local normal cells and are graded according to how closely or not they do. Grading is as follows:

From G1, the cancer cells mimic normal cells, through G4, the cancer cells are noticeably different from normal cells.

These four numbers are then used for general staging of the cancer:

T1, N0, M0, and G1 equals Stage I, or early stage cancer confined to a small portion of the prostate. T2, N0, M0, and G2 to G4 equals Stage II, or early stage cancer that has spread throughout a larger portion of the prostate. T3, N0, M0, and any G equals Stage III, or cancer that has spread completely though the prostate capsule, but not yet outside the prostate. T4, any N, any M, and any G equals Stage IV, or cancer that has left the prostate to invade other organs, either nearby or distantly.

Once the cancer is staged, the doctor can better judge treatment options and aggression. However, age and other risk factors are usually taken into account. For instance, even in more advanced stages some doctors may discover a lower risk in a patient and only prescribe radiation treatment and not hormonal treatment. Or vice versa. Staging only gives a good overall snapshot of the cancer and it’s immediate danger.

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The 4 Most Common Treatment Options for Cancer of the Prostate

Treatment for prostate cancer is highly variable and must take into account your age, how far your cancer has spread, and your own decisions. In general, your doctor will offer you several choices, most commonly surgical removal of the prostate, radiation treatment, and watchful waiting. Hormonal therapy is often considered for more advanced stages of cancer. Since prostate cancer hits most men so late in life, there has been some concern recently that it can be overtreated. Some men may die of other causes long before the cancer can have any effect, and some are of the opinion that treatment can in some cases cause more pain and discomfort than the cancer ever will. Again, these are all options that will have to be discussed with your doctor. However, here we will list the available treatments and what their pros and cons of each.

Radical Prostatectomy: Removal of the entire prostate gland. Pros: Removes all the localized cancer and gives the doctor a closer look at the gland for a better look at how much the cancer has spread. cons: Long hospital stay, long recovery time, possible permanent impotence.

Watchful Waiting: Checking prostate specific antigen levels every few months to see if they go up. Pros: Non-invasive. Cons: Cancer could quickly become agressive and spread.

Radiation Treatment: Irradiating the prostate through external means or the implanting of radioactive “seeds.” Pros: Less invasive than surgery. Cons: Possible problems with incontinence or diarrhea.

Hormone Therapy: Reduction of testosterone through hormonal treatment. Pros: Useful for more advanced forms of prostate cancer. Cons: Variable side-effects can occur depending on the treatment used.

Treatment for this cancer can be effective in many cases and not so effective in others. Fortunately there is a large menu of treatments available that can be tailored to each individual’s unique set of circumstances. More aggressive treatment may be forgone in older patients as quality of life can be severely affected. Some doctors will make a judgement as to how long a patient’s life span is and consider the treatment that will delay cancer the longest while allowing the patient to lead the most comfortable life possible.

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  • Radiation Therapy for Prostate Cancer
  • Various Prostate Cancer Surgery Options
  • Is Watchful Waiting a Viable Treatment Option?
  • Minimally Invasive Surgery for Prostate Cancer
  • 3 New Treatments for Prostate Cancer
  • How Prostate Staging Helps Your Doctor Evaluate Treatment Options
  • The 4 Most Common Treatment Options for Cancer of the Prostate

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