Prostate Cancer Treatment Options-Overview
This section is dedicated to a broad overview of various options available for the treatment of localized prostate cancer. Detailed descriptions, pros, and cons of these options will be found on the links associated with each option. Treatment options for prostate cancer include those that do not intend to cure and those that are intended to cure the cancer. Watchful waiting and hormonal therapy are non-curative. Surgery and radiation are performed with the intention of curing the cancer.
Surgical Options are divided into two categories, open and laparoscopic. All surgical methods result in complete removal of the prostate and seminal vesicles. In selected patients nerve sparing prostatectomy is performed to preserve erections and sexual function. In selected patients pelvic lymph nodes are also removed. Open surgery involves making moderate to large skin incisions to perform the surgery. Laparoscopic methods, including daVinci Prostatectomy, are less invasive and involve making tiny incisions, placing a camera inside the body, and placing pencil thin instruments to do surgery without cutting the body open.
Minimally Invasive Surgical Methods for Prostate Cancer
daVinci Robotic Laparoscopic Prostatectomy: Prostatectomy is performed with more accuracy using the state-of-the-art daVinci computer enhanced minimally invasive surgical system. This system utilizes microscopic surgical instruments held by robotic arms, which are controlled by the surgeon from the surgical console with a three dimensional digital viewing monitor. As the surgeon moves his/her fingers, wrists hands, and arms, the robot mimics these delicate movements onto the surgical instruments. The 3-D viewing screen allows for the surgeon to "feel immersed" within the patient. The highly magnified view provides for the surgeon to differentiate between healthy and diseased tissue.
- Because the pencil thin tips of the instruments are able to move like a tiny wrist around the prostate, the operation is performed with a high degree of accuracy. With the state-of-the-art daVinci Robot computer, the surgeon performs the same procedure done in open surgery but is aided by a three-dimensional computer vision system to manipulate four robotic arms. A pencil-size video camera held by one of the arms is inserted through an incision to provide magnified, 3D images of the surgical site. The 3D view helps the surgeon more easily identify the delicate nerves and muscles surrounding the prostate. The robotic arms can rotate a full 360 degrees, allowing the surgeon to manipulate surgical instruments with greater precision, flexibility, and range of motion.
- This translates into patients experiencing less blood loss, quicker recovery time (two to three weeks, including just two or three days initial hospitalization), and fewer side effects, such as urinary incontinence and sexual dysfunction – a huge consideration for patients when choosing a treatment option.
In this procedure small keyhole puncture sites are created on the abdomen. A small telescope is placed inside the belly button. Pencil thin instruments held by the surgeon are introduced via small ports in the puncture sites. Using these microscopic instruments, the surgeon performs the operation, gently freeing the prostate and seminal vesicles and avoiding trauma to the surrounding tissue. The prostate and seminal vesicles are removed intact (in one piece), and delivered outside the body through the belly button. Lymph nodes are similarly removed. The bladder is then attached back to the urethra. A nerve sparing procedure can be performed to maintain the patient's pre-surgical level of sexual function.
- Radical Open Retropubic Prostatectomy
- Radical Open Perineal Prostatectomy
Radiation is divided into two broad categories: External Radiation and Brachytherapy.
This is a method in which a machine generates and sends radiation from outside to penetrate the inside of a patient's body. These radiation beams then reach the prostate in an attempt to destroy the cancer. There are different types of external radiation machines that create different type of radiation beams:
- Helical Tomotherapy
- Intensity Modulated Radiation Therapy (IMRT)
- Proton Beam Radiotherapy
- 3-Dimensional Conformal Beam Radiotherapy
This is a method in which radioactive seeds are implanted into the patient's body. These implanted radioactive devices, then emit radiation directly from the inside of the patient's body (his prostate) in an attempt to destroy the cancer from the inside. There are different types of brachytherapy:
- Real Time Transperineal Ultrasound Guided Seed Implantation
- Preplanned Transperineal Ultrasound Guided Seed Implantation
Watchful Waiting/Active Surveillance
In some cases, the prostate cancer may be so slow growing as to present a minimal threat to the patient's life, especially if it is detected in a patient with advanced age. In these cases, no treatment is given. The patient is seen by a physician every few months for DRE, PSA and possible x-rays.
Prostate cancer growth can be temporarily slowed by hormone therapy. Prostate cancer growth is partially dependent on testosterone, a hormone produced by the testicles and adrenal gland in men. Hormone therapy can stop the production of testosterone, or block attachment of testosterone to prostate cancer cells. Hormone therapy can, therefore, temporarily slow the progression of the cancer. Prostate cancer usually escapes the need for testosterone over time and starts growing rapidly despite hormone therapy. This type of prostate cancer is called "hormone refractory prostate cancer."