Facing a prostate cancer diagnosis can be overwhelming, but understanding the available treatment options can provide a sense of empowerment and guide you towards making informed decisions. In this blog, we delve into the various treatment options for prostate cancer, exploring surgical interventions, radiation therapy approaches, hormone therapy, and the latest advaces in Focal Therapy By gaining knowledge about the benefits, potential side effects, and considerations for each treatment, you can navigate your prostate cancer journey with confidence and take an active role in your treatment plan.
Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. It’s one of the most common types of cancers, and it usually affects older adults. In America, one man out of eight has a prostate cancer diagnosis each year, making it the 2nd most common form of cancer in men
There are many ways to treat prostate cancer, depending on the stage of the cancer. The stage refers to how much the cancer has grown and spread. Many patients are advised to take a wait and see approach, a.k.a. Active surveillance, when treating prostate cancer that is in the early stages (stage I or II). However, next generation prostate cancer treatments are now available to specifically destroy prostate cancer cells while preserving healthy tissue so that your prostate can still function after prostate cancer treatment.
Metastatic prostate cancer, also known as advanced prostate cancer, will require a systematic approach that treats multiple areas of the body to kill cancer cells that have spread through the lymphatic system and bloodstream. To treat prostate cancer starts with getting an accurate diagnosis and it is advised to get a second opinion from a board certified urologist. To effectively treat advanced prostate cancer, a combination of treatments can optimize results.
The prostate is a gland in the reproductive system. It’s located above the perineum (the space between the anus and scrotum) and below the bladder, . It measures about the size of a walnut and covers the area around the urethra, which dispenses urine in the bladder. The prostate produces seminal fluid, which protects and transports sperm.
Unfortunately, it’s not yet known what causes prostate cancer to develop. Doctors do, however, know how it develops.
Prostate cancer begins with the DNA. The cells in each part of the body contain DNA, which acts as a blueprint for the creation of new cells. Sometimes, cellular DNA is corrupted, and the blueprint is altered. The new blueprint instructs cells to grow and divide more rapidly than they’re supposed to.
Additionally, healthy cells have a life cycle in which they are created, grow, and then die. But the new, abnormal cells – the cancer – continues living, growing, and spreading instead of dying. Because they don’t die naturally, the abnormal cells collect and form tumors which may spread and invade other parts of the body.
While doctors don’t yet know what causes the DNA to be altered, there are several factors that can increase your risk of developing prostate cancer. These include:
Age: Your risk of prostate cancer increases as you age. It's most common after age 50.
Race: For unknown reasons, Black people have a greater risk of prostate cancer than do people of other races. In Black people, prostate cancer is also more likely to be aggressive or advanced.
Family history: Your risk of developing prostate cancer is increased if a blood relative, such as a parent, sibling or child, has been diagnosed with either prostate cancer or breast cancer.
Prostate cancer treatment options can be broken up into 4 categories:
Local Treatment for Prostate Cancer
Systemic Treatment for Prostate Cancer
Combination of Prostate Cancer Treatments
In older men without symptoms of prostate cancer, active surveillance, also called watchful waiting, is a method used to prevent the disease. With watchful monitoring, patients are closely observed and not treated unless there are signs or changes in their condition that require intervention. The goal of treatment is to reduce symptoms and improve overall health. This approach allows for early detection of worsening symptoms.
However, with the next generation of prostate cancer treatment options coming to light, such as Focal Therapy (TULSA-Pro), many physicians are trying to reduce the prostate cancer with fewer side effects than more standard treatments. To learn more about active clinical trials, please contact Dr. Kia Michel at Comprehensive Urology in Beverly Hills.
Local treatments refer to procedures that can remove cancer from a specific region of the body. These methods include surgical procedures and radiotherapy. In the early stages, the cancerous tumor can be treated locally by reducing its size. If the cancer has spread beyond the prostate gland, additional treatments may be necessary, such as a combination of medication and chemotherapy to destroy tumors found elsewhere. Surgery involves removing the prostate gland and a lymph node during the operation. Surgical oncologists are medical specialists who treat cancer using surgery, while urological oncologists are surgical oncologists who specialize in treating prostate tumors through other means.
One of the most common local treatments for prostate cancer is robotic-assisted surgery, which often entails a prostatectomy (a complete removal of the entire prostate cancer gland.) By removing the entire prostate gland, the prostate cancer cells are removed along with healthy tissue. This has become a gold standard in the treatment of prostate cancer; however, it also comes with a higher incidence of urinary incontinence and erectile dysfunction because none of the prostate will remain in the body to perform its functions after a radical prostatectomy.
Newer forms of local treatment of prostate cancer are currently being studied. These newer treatment modalities include Focal Therapy, like TULSA-Pro (the TULSA procedure), which targets just the prostate cancer cells while preserving the healthy tissues of the prostate gland to minimize the side effects of urinary incontinence and erectile dysfunction.
Focal Therapy is a new treatment option for prostate cancer and BPH that either heats or freezes focused areas of the prostate instead of removing the prostate. It is typically used in early-stage prostate cancer treatment (Stage I and II).
The two primary forms of Focal Therapy are TULSA-Pro and HIFU. HIFU uses high-frequency sound waves to destroy cancerous tissue. It has a shorter recovery time than traditional cancer treatments, with less likelihood of side effects. HIFU is performed with a larger device inserted into the anus.
TULSA, on the other hand, uses high-intensity ultrasound waves to heat and destroy cancerous tissue within the prostate while minimizing damage to surrounding healthy tissue. TULSA-Pro is performed in an MRI machine with a small device inserted into the urethra.
The TULSA-PRO procedure is a personalized, minimally invasive approach for treatment of both prostate cancer and an enlarged prostate. This allows for customization of the treatment to suit individual situations and improves preservation of sexual and urinary function. The TULSA-PRO can effectively destroy cancerous cells while preserving healthy cells and is carefully planned to minimize the common side effects of prostate surgery, such as loss of bladder control and erectile dysfunction (ED).
Ongoing Clinical trials are confirming their efficacy and side effects compared to the more standard surgery and radiation options. The TACT study showed that TULSA-Pro resulted in a 95%+ reduction in PSA (prostate specific antigen) four years after the treatment, and only a 20% side effect of erectile dysfunction. TULSA-Pro is currently in the CAPTAIN study to see if it is as effective and safe as robotic surgery. Dr. Kia Michel is an investigator in this study, and you can contact Comprehensive Urology today to see if this treatment is right for you. Book an appointment.
Radiation therapy usually comes in two forms: beam radiation therapy and brachytherapy (seed radiation therapy). Prostate cancer can be treated effectively with radiation therapy, which destroys cancer cells using high-energy rays or particles.
Radiation can be administered through external beam radiation, which delivers energy through the skin. Or, it can be administered through brachytherapy, which is also known as seed implantation, interstitial radiation therapy, or internal radiation therapy.
Brachytherapy involves the insertion of tiny radioactive seeds (0.8mm thick and 4.5mm long) into the prostate using needles inserted just behind the scrotum for permanent (low dose rate) treatment. These seeds emit radiation to immediately destroy cancer cells surrounding them for several months until the radioactivity dissipates. Enclosed in titanium, the seeds can remain safely in the body, and ultrasound, CT scans, and MRI scans can be used to ensure accurate placement.
To achieve the best results, prostate cancer radiation therapy should be administered by experienced radiation oncologists working in high-volume centers of excellence. Radiation therapy is versatile and can be used to treat early-stage prostate cancers, advanced cancers that have spread beyond the prostate, and recurrent prostate cancer following surgery, either alone or in combination with other therapies, like hormone deprivation.
Chemotherapy is a form of systemic prostate cancer treatment that injects chemicals into the bloodstream. These chemicals are absorbed more rapidly by cancer cells than healthy cells. Chemotherapy can impede the growth of tumors and can cause apoptosis (cell death) in prostate cancer cells. This reduces the spread of cancer and can even lead to remission of cancer. System-wide approaches are more often used in advanced prostate cancer (Stage IV) because the cancer has spread (metastasized) to other parts of the body, such as the lymph nodes and bones.
Hormone Therapy is a systemic prostate cancer treatment that uses a shift in the hormones to impact the growth of cancer cells in the prostate gland. Hormone therapy, also known as androgen deprivation therapy (ADT), is a common treatment approach for prostate cancer. Prostate cancer cells rely on male hormones called androgens, such as testosterone, to grow and multiply. Hormone therapy aims to lower the levels of androgens in the body or block their effects on cancer cells.
Our patients often ask us similar questions to learn more about prostate cancer and the available treatment options for prostate cancer after receiving their diagnosis.
Prostate removal surgery, also known as a prostatectomy, is a common treatment option for prostate cancer. While the surgery can be effective in removing cancerous tissue, it can also lead to certain side effects. These side effects can vary from person to person and may be temporary or long-term. Some of the potential side effects of prostate removal surgery include:
Erectile Dysfunction: One of the most common side effects is difficulty achieving or maintaining an erection. Nerve damage during surgery can affect the blood flow and nerve signaling necessary for erections. However, with time and appropriate treatment, many men can regain erectile function.
Urinary Incontinence: Another common side effect is urinary incontinence, which involves leakage or difficulty controlling urine. This can occur due to damage to the muscles and nerves that control bladder function during surgery. Incontinence can range from mild to severe, and there are treatments, such as pelvic floor exercises and medications, to help manage this issue.
Changes in Ejaculation: Prostatectomy can cause changes in ejaculation. Some men may experience dry orgasms, where little to no semen is ejaculated, while others may notice a decrease in the volume of ejaculate. These changes are due to the removal of the prostate gland, which produces a significant portion of seminal fluid.
Infertility: Prostatectomy can lead to infertility, as the surgery involves removing the prostate gland and seminal vesicles, which play a role in sperm production and transport. If preserving fertility is a concern, it's important to discuss options with a healthcare provider before undergoing surgery.
The prostate is a gland found in men. It is part of the male reproductive system and plays a role in the production and transport of semen. During ejaculation, the prostate's muscular contractions help propel semen into the urethra.
The prostate gland is under the influence of male hormones, particularly testosterone. It typically grows larger as men age, a condition known as benign prostatic hyperplasia (BPH). However, the prostate can also be susceptible to diseases, including prostate cancer. Regular check-ups and screenings are recommended to monitor the health of the prostate and detect any abnormalities early.
For early-stage prostate cancer (stages I and II), the standard treatments are surgery and radiation therapy. However, next generation prostate cancer treatments, such as Focal Therapy (TULSA-Pro and HIFU), use ultrasound to ablate (destroy) the cancerous areas of the prostate gland without removing it or making a single incision. For more advanced prostate cancer, in which the cancerous cells have spread outside of the prostate, the most common treatments are surgery and chemotherapy.
Ongoing Clinical trials are confirming their efficacy and side effects compared to the more standard surgery and radiation options. One such treatment that is being studies is the TULSA procedure (TULSA-Pro). The TACT study showed that TULSA-Pro, which inserts a device into the urethra while the patient is in an MRI machine, showed that there was a 95%+ reduction in PSA (prostate specific antigen) four years after the treatment and only a 20% side effect of erectile dysfunction. TULSA-Pro is currently in the CAPTAIN study to see if it is as effective and safe as robotic surgery. Dr. Kia Michel is an investigator in this study and you can contact Comprehensive Urology today to see if this treatment is right for you. Book an appointment.
The use of radiation during therapy could result in increased urinary urges, difficulties with sexual functions, or problems in the bowel, including diarrhea, nausea, rectal pain, and fatigue. Typically, this side effect disappears after therapy. To assist in sexual function, injections are usually required. While rare, some patients experience radiation effects several years after treatment.
Prostate cancer is a complex disease. Determining the most appropriate treatment option requires careful consideration. The choice of treatment depends on various factors, including the stage and grade of the cancer, the overall health and preferences of the individual, and potential side effects.
It's important to consult with a healthcare team to discuss the available treatment options, weigh the potential benefits and risks, and make an informed decision based on individual circumstances. Additionally, engaging in open communication, seeking support from loved ones or support groups, and maintaining a healthy lifestyle can contribute to overall well-being during prostate cancer treatment.
Remember, each person's journey with prostate cancer is unique, and treatment decisions should be tailored to meet their specific needs. By staying informed, actively participating in decision-making, and having a supportive network, individuals can navigate the challenges of prostate cancer treatment with confidence and a hopeful outlook for the future.
If you experience symptoms, take charge of your health by scheduling an appointment with Dr. Kia Michael at Comprehensive Urology. His experienced, board-certified team can help you catch cancer early and treat it with minimal complications.
New Focal Therapy for Prostate Cancer Treatment