Dr. Brett Parkinson with Mountain Medical discusses the options.
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OPTIONS FOR PROSTATE CANCER TREATMENT:
• Surgery
• Radiation Therapy
• Hormone Treatment
• Chemotherapy
• Watchful Waiting
SURGICAL OPTIONS
• Open Radical Prostatectomy
• Laparoscopic Radical Prostatectomy
• Robotic-Assisted Radical Prostatectomy
OPEN RADICAL PROSTATECTOMY
• Surgical removal of the prostate gland and surrounding tissue through an incision
• Retropubic Approach: Surgeon makes incision in lower abdomen, removing prostate gland, some surrounding tissues and lymph nodes. A nerve-sparing version of this procedure can be performed, decreasing risk of erectile dysfunction.
• Perineal Approach: Surgeon removes prostate gland through incision between the scrotum and anus. Performed less often than the radical procedure, as lymph nodes can’t be removed with this technique. Not a good approach for nerve sparing.
• With both approaches a catheter into the bladder during surgery, remaining in place for 10 to 21 days after. This facilitates urination during recovery.
• Average hospital stay is 3 days. Time away from work, 3 to 5 weeks
LAPAROSCOPIC RADICAL PROSTATECTOMY
• Minimally invasive surgery
• Surgeons look inside abdomen with a special camera or scope>>five small incisions (or portholes) are made: one below navel, two each on either side of abdomen>>carbon dioxide introduced into abdomen, allowing for better visualization of abdominal cavity>>surgeons remove gland through laparoscope as they monitor images of their progress on a video screen.
• Advantages over open radical prostatectomy: less blood loss, less need for pain medication, shorter hospital stays, quicker return to regular activities.
• Not performed if disease has spread outside of the prostate gland, or if patient has had previous open or laparoscopic pelvic surgery.
• Although long-term data not yet available, early studies indicate incontinence and impotence rates are similar to traditional surgery.
ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY
• Approved by FDA as alternative to open and conventional laparoscopic radical prostatectomy
• Surgery, though orchestrated by the surgeon, is actually performed by a robot
• Easier to perform than laparoscopic surgery. Shorter learning curve for surgeons.
• Early data suggest comparable outcomes to open and traditional laparoscopic techniques.
RADIATION THERAPY
• External Beam Radiation
• Radioactive Seed Implants
EXTERNAL BEAM RADIATION
• High doses of radiation directed at prostate from a machine outside of the body
• Regular, daily sessions (M-F) during a eight- to nine-week period; each treatment only lasts a few minutes
• Marks that look like freckles made on skin along treatment area
• Side effects can include redness, swelling and skin sensitivity; long term side effects can also include erectile dysfunction and urinary problems (frequency, bleeding, but rarely incontinence)
RADIOACTIVE SEED IMPLANTS
• Permanent (Low Dose Rate) Brachytherapy: Radioactive seeds places in prostate under ultrasound guidance. 40 to 80 seeds usually implanted. Remain in place permanently, becoming biologically inert. Allows delivery of high dose to prostate with minimal exposure to surrounding tissues.
• Temporary (High Dose Rate) Brachytherapy: Hollow needles placed in prostate gland which are filled with radioactive material. Left in place for 5 to 15 minutes, after which removed. Repeated two to three times over next several days. Although needles removed, implants remain permanently.
• Best candidates for procedure are those with disease confined to prostate which is not aggressive; PSA less than 10.
HORMONE THERAPY
• Anti-testosterone agents used to impede tumor growth
• Orchiectomy–surgical removal of testicles
CHEMOTHERAPY
• Not used to treat early stage disease; reserved for cases of advanced or recurrent disease that have not responded to hormone therapy
• One or more cancer-killing agents given intravenously
• Given in cycles of treatment, usually followed by a rest period
• Goal is to destroy or shrink tumor; also used to treat metastatic disease
WATCHFUL WAITING
• Wait-and-see approach
• May be appropriate for older men with small, low-grade tumors and slowly rising PSAs; men for whom surgery and radiation therapy are contraindicated for medical reasons; and men whose life expectancy is less than ten years
There is no agreement, even among experts, just how prostate cancer should be treated. The best approach is multidisciplinary, meaning a team approach with doctors representing surgery, radiation therapy and medical oncology.
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