What should you know about prostate cancer treatment?
Our urology experts offer a range of treatment options based on various factors and diagnostic results.
Watchful waiting or active surveillance
Watchful waiting refers to a treatment strategy in which no invasive treatment for prostate cancer is performed, but rather the patient’s symptoms, PSA level, and aggressiveness of the cancer is monitored over time. This can be a very safe way of managing many patients with prostate cancer. Most patients recommended for this treatment are older or will have other medical conditions that may limit their overall life expectancy. However, younger patients with a very low volume of cancer that is felt not be overly aggressive may also qualify for this type of treatment. The biggest risk is having a cancer that may be growing more aggressively than expected; however, the natural history of prostate cancer is considered to be fairly slow growing and this treatment option is considered safe as long as the patient adheres to a strict follow-up regimen. Some patients may be counseled to receive a repeat prostate biopsy within a specified time period after initial diagnosis.
Localized therapy using radiation, cryotherapy, HIFU
A variety of different treatments are available to treat the prostate without removing it from the body. They can include use of radiation either through radiation beams shot through the skin or using seeds implanted in the prostate, cryotherapy which uses freezing rods placed through the skin to freeze the prostate, or newer therapy using high intensity focused ultrasound shot through the skin to destroy the prostate. These procedures are considered highly effective in certain forms of cancer, however, are not always appropriate for every patient. All of these procedures have their own risks and types of complications and will need to be discussed carefully with your treating urologist.
Surgery for prostate cancer (radical prostatectomy)
Some patients will be counseled on the potential benefit of surgical removal of the prostate. Although this can be done through an open incision, most of these procedures are now performed laparoscopically using the surgical assistance of da Vinci™ Surgical Robot System. This type of operation allows the prostate to be removed through 5 or 6 small incisions in the lower abdomen. Recovery is generally considered fairly rapid with most patients going home the next day. Complications rates are low but this procedure may not be appropriate for all patients or for all forms of cancer.
Hormones and chemotherapy
Advanced prostate cancer is defined as a cancer that has escaped beyond the prostate possibly into the lymph nodes, occasionally into the bone, or other organs. In some cases, the exact site of spread of the cancer is not known, but the PSA might be rising even after treatment. In such cases, hormone therapy is often initiated. Hormone therapy refers to the use of medications that will either reduce the amount of testosterone in the body or block the action of testosterone. Testosterone is a hormone that can be used by prostate cancer cells to grow more quickly, and the removal of testosterone from the body can slow the growth of some cancers. It is believed that most patients, however, will ultimately develop cancer that is not dependent on testosterone and this type of cancer is called hormone-refractory prostate cancer.
When cancer becomes hormone-refractory, oftentimes chemotherapy is initiated. Recent advances in chemotherapy have allowed several drugs to be introduced for the treatment of advanced prostate cancer. Because the treatment is constantly evolving, patients with hormone-refractory prostate cancer are often referred to an oncologist for the most advanced treatment.
Contact us to schedule an appointment with one of our Central Texas urology experts.
