Prostate Cancer Treatments

By Anshu Guleria, MD

Prince William Urology Associates

. http://www.guleriaurologyassociates.com/

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Prostate Cancer Treatments

Prostate cancer (PCa) is the most common cancer in men in the U.S. Last year, about 220,000 men were diagnosed with the disease and about 32,000 men died from PCa. Death rates for PCa have declined steadily since 1995. The improved death rate is likely due to early detection and better treatment options.

For over 50 years, the management of localized prostate was divided into four general categories surgery, radiation therapy, hormonal therapy and active surveillance. Recent treatment advances have gained a lot of interest from patients and their doctors.

Radical prostatectomy involves removing the prostate gland and attached seminal vesicles. The surgery may be done through a four-inch incision in the lower abdomen or with five smaller incisions using instruments guided by robotic arms controlled by the urologist.

Surgery offers the knowledge that the cancer has been removed from the patient, and the prostate may be examined by the pathologist to confirm the extent of spread of the PCa. The most common and lasting effects are urinary incontinence and erectile dysfunction.

Radiation therapy may be delivered as external beam therapy or radioactive seeds may be placed in the prostate via ultrasound guided needles. Radiation therapy offers the advantage of a nonsurgical approach and is particularly attractive for patients who are over age 70 or have other serious medical illnesses.

Over the past decade, cryoablation for PCa has become a good non-surgical and non-radiation option. Cryoablation involves the controlled freezing of the prostate gland in order to destroy cancerous cells. Damage caused by freezing occurs at several levels molecular, cellular and whole tissue structure.

Another newer technique available over the few years is high intensity focused ultrasound (HIFU). Like cryoablation, HIFU uses ultrasound guidance to identify and destroy the prostate gland tissue. Unlike cryotherapy, the treatment is done without needles and uses focused sound waves to heat the targeted tissue to cause cell death. HIFU has yet to be approved by the U.S. FDA. Clinical trials are underway and the treatment may become available by early 2012 in the US. Patients may go to Canada or Caribbean locations to have HIFU under the care of U.S. trained doctors and staff.

Hormonal therapy involves periodic injections of medication to suppress testosterone production. Testosterone stimulates growth of PCa and its suppression can reduce prostate tumors and their overall size. Often, hormonal therapy is used prior to starting a local therapy such as radiation, cryotherapy or HIFU. Hormonal therapy results in side effects of “hot flashes”, weight gain, fatigue, osteopenia.

Many prostate cancers grow slowly and aggressive treatment may not be needed in all patients. Patients with low-risk cancers (low PSA, low-grade cancer) or with other competing health issues may be offered active surveillance. The patient and doctor must understand that the cancer is still present, and about half the men on active surveillance will eventually need treatment for their cancer.

Prostate cancer remains a highly treatable disease and men over 50 should be checked annually. Discuss the treatment options and their risks and benefits with a physician who specializes in the treatment of prostate cancer. The goal is to provide each patient with a treatment plan that is tailored to their overall health and to their specific cancer.