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Treatments for Early Stage Prostate Cancer
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Men who are determined to have early stage prostate cancer have a high likelihood that their cancer is still limited to the prostate and has not spread elsewhere. Most men with early stage disease have an excellent prognosis and with current treatment options have a high likelihood of becoming cancer free.
Patients who have early stage disease have several options for treatment including::
Active Surveillance
Surgery
External Radiation Therapy
Brachytherapy
Cryotherapy
Hormonal Therapy
Active Surveillance
Active Surveillance or, as some call it, watchful waiting, may be an option for older men with a relatively shorter life expectancy, especially if the cancer is small and slow growing. Chances are good that without any form of treatment the cancer will not affect them in their lifetime. However, for men who are healthy and have longer life expectancies (greater than 10 years), some type of active treatment to potentially cure the disease is generally recommended
Active surveillance involves monitoring the cancer by:
Assessing the clinical symptoms of the patient,
Monitoring his prostate with rectal examinations and PSA testings,
Imaging the prostate, and
Repeating the prostate biopsies aton regular intervals
Surgery
Recent studies demonstrate that, for patients with early stage disease, surgery affords the best long term cancer control as compared to any other available treatment option. With the development of newer, more advanced surgical instrumentation, patients are able to undergo prostate surgery and achieve excellent cancer control while optimizing their recovery and preservation of function.
Surgery (called Radical Retropubic Prostatectomy) is considered the gold standard and most common treatment for prostate cancer. The surgeon removes the prostate while sparing muscles and nerve fibers surrounding the prostate gland that control erectile function and urination.
Open radical retropubic prostatectomy (the “open” approach) is performed using an incision from the lower abdomen from just below the umbilicus to the pubic bone. The prostate is removed through this incision while sparing the nerves and muscles surrounding it which help to control urination and sexual function. It is the traditional method of prostate removal and sampling of the lymph nodes surrounding the gland where the cancer can potentially spread. The gland is surgically removed, and the surgeon then reconnects the bladder to the urethra to reconnect the urinary tract.
With the advent of newer surgical technology, surgery is now being done in a minimally invasive manner termed the Davinci prostatectomy (or robot-assisted radical prostatectomy). The benefits of open surgery are maintained (excellent cancer control, preservation of urinary control and erectile function) while using minimally invasive surgical techniques . This results in smaller incisions, less bleeding, less pain, shorter hospitalization and a much faster recovery time. Preliminary data also suggests a more rapid return of urinary control and erectile function with the “robotic” approach.
Click here to learn more about robotic surgery...
FAQs
External Radiation Therapy
Radiation therapy for prostate cancer can take different forms- either externally beamed from a machine or by radioactive seeds implanted in the prostate (see brachytherapy for prostate cancer). It can be used as an alternative to surgery for localized prostate cancer, or to treat cancer that has spread beyond the prostate. In certain clinical situations, radiation treatment can be useful in treating prostate cancer after surgery. Radiation therapy can also help shrink tumors in men with advanced disease, and may also be used to relieve pain caused by prostate cancer.
Radiation therapy has recently been more widely used in conjunction with hormonal therapy in the treatment of more aggressive localized prostate cancer.
The course of external beam radiation therapy is usually 6-8 weeks. Newer therapies are continuously being developed (ie. Conformal beam radiotherapy, intensity modulated radiotherapy) to improve localization of radiation treatment to the prostate without damaging adjacent structures like the bladder or rectum. Widespread long-term data is awaited to determine durable cure rates compared to other therapies such as radical prostatectomy.
Brachytherapy
Radioactive seed implants are placed into the prostate gland to help localize radiation treatment to the prostate and minimize the effects to the surrounding structures (bladder and rectum). The technique is performed by implantation through the skin utilizing ultrasound and x-ray for localization into the gland. Results published to date show good control of cancer at 5-8 years following treatment in persons with very low grade cancers. Overall, the treatment appears to be as effective as external radiation. Long-term results are awaited in order to determine durable cure rates compared to radical prostatectomy.
Cryotherapy
Cryotherapy is performed by freezing the prostate with liquid nitrogen. In the operating room, small probes are placed by ultrasound guidance into the prostate and then are used to freeze the gland, while the urethra is monitored to minimize the risk of damage to it as well as the rectum. It was first developed in the 1960’s and refined in the early 1990’s but had significant side effects to the urinary tract and rectum. Improved technology and the use of ultrasound has allowed for improved localization of treatment to the prostate gland. The overall cure rate with this technique for primary prostate cancer is yet to be determined due to the short term data that is available.
The therapy has gained more widespread acceptance not in the primary treatment of prostate cancer, but in the recurrence of prostate cancer after radiation treatment has failed. It appears that this may be the more promising role for cryotherapy in the treatment of prostate cancer.
Hormonal Therapy
Many men choose hormonal therapy for advanced prostate cancer to help cut off the supply of the hormone (testosterone) that makes prostate cancer cells grow faster. As it is not a curative mode of treatment, it is generally not used in early prostate cancer. Hormonal control can be achieved through the use of medications or through surgical means. The medications used help to stop the production of these hormones or block them from feeding the cancer cells. Surgical options include removal of the testicles, which are the main source of testosterone production in men.
Hormonal therapy targets cancer that has spread beyond the prostate gland and is thus beyond the reach of local treatments such as surgery or radiation therapy. Hormonal therapy is also helpful in alleviating the painful and distressing symptoms of advanced disease. It is also being used in conjunction with external radiation therapy for more aggressive but localized prostate cancer. Furthermore, it is also used as a treatment for prostate cancer recurrence after previous treatment. Although hormonal therapy cannot cure prostate cancer, it will usually shrink or halt the advance of disease, often for years. With hormonal control, about half of men who have prostate cancer spread to other organs in the pelvis live at least 5 years.
General Information
Risk Factors for Prostate Cancer
Prostate Cancer Screening & Prostate Biopsy
Grading and Staging of Prostate Cancer
Treatment Options for Advanced Stage Prostate Cancer
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