Prostate Cancer Treatment

• Watchful Waiting

  Because prostate cancer is often slow-growing, watchful waiting is a possible choice for men with Stage I or Stage II cancer with low or intermediate Gleason grades. This is a less-frequently-chosen response for Stage III and IV patients, but even they are sometimes appropriate candidates for watchful waiting. Digital rectal examinations and prostate-specific antigen tests are done every six months and a prostate biopsy is performed yearly to detect growth or changes in the cancer.

• Surgery
  • Radical Prostatectomy
    Radical prostatectomy is the removal of the entire prostate gland and some surrounding tissue. Radical prostatectomy is most frequently performed with an incision in the lower abdomen, but at times the incision is in the area between the scrotum and rectum. Radical prostatectomy is often associated with impotence and incontinence.

  • Nerve-Sparing Prostatectomy
    If cancer has not grown to or beyond the edge of the prostate gland, a nerve-sparing prostatectomy is possible. In this procedure the surgeon removes tissue near , but not all the way too, the edge of the prostate. The erectile nerves alongside the prostate are spared, and normal sexual function is often retained.

  • Transurethral Resection
    Transurethral resection removes some, but not all prostate tissue using a resectoscope (a fiber-optic tube with a viewing lens, light and cutting instrument at the end).

  • Laparoscopic Surgery
    New laparoscopic surgical techniques, including robotically-assisted surgery, use a smaller incision - and frequently have fewer side effects - than conventional surgery.

  • Pelvic Lymphadenctomy
    Pelvic lymphadenectomy is the surgical removal of the lymph nodes in the pelvis. It is usually performed at the same time as a radical prostatectomy.

  • Orchiectomy
    Orchiectomy, the removal of one or both testicles, is usually done along with a radical prostatectomy for more advanced (usually stage IV) prostate cancer.

• External-Beam Radiation Therapy

  External-beam radiation therapy is used in both curative and palliative treatment. A map of the tumor's location is created with a CT scan, and the tumor is radiated from different angles to maximize the dose delivered to the tumor with minimum impact on surrounding healthy tissue.

  • TomoTherapy
    TomoTherapy is a new radiation therapy technology which has pioneered at Thompson downtown. Thompson treated the world's first TomoTherapy prostate cancer patient.

  • IMRT
    Thompson Cancer Survival Center was one of the first facilities in the world to treat patients with intensity modulated radiation therapy. Since 1998 more than 1,000 patients have received IMRT treatment at Thompson. Now both Thompson Downtown and Thompson at Methodist offer this treatment. In IMRT the multileaf collimator reshapes the treatment field between individual doses of radiation, so the beam is matched to the shape of the tumor from all angles.

  • Prostate dose escalation
    The higher radiation dosage of prostate dose escalation has increased patients' disease-free survival rates from 15% to 85% in a Fox Chase Cancer Center study.

    The improvement was so dramatic that Thompson adopted the technique as soon as the study was published in 1996. Prostate dose escalation relies upon 3-D treatment planning, a technique pioneered at Thompson.

• Prostate Seed Implants

  Thompson at Methodist and Thompson Downtown both perform prostate seed implants. Radioactive pellets are implanted directly into the tumor.

  Thompson Downtown has developed real-time technology in which the tumor is mapped with an ultrasound probe and seed placement planned in the operating room immediately before the implant procedure.

  This assures that seeds are planted based on the size, shape and location of the tumor at the time of the procedure. Seeds are tracked so the radiation dose is evaluated during the procedure and adjustments can be made immediately.

• Chemotherapy

  Chemotherapy is not widely used to treat prostate cancer. It is most often used for advanced metastatic disease or when hormone therapy was no longer effective. Recent advances are expanding chemotherapy's role in prostate cancer care, and clinical trials of several new applications are now under way.

• Clinical Trials

  SWOG S9346	Stage 2 D Prostate Cancer: CAD versus Observation.
  RTOG 0126	Prostate Cancer: HD 3D-CRT/IMRT vs. Standard Dose 3D-CRT/IMRT.
  CALGB C90401	Hormone refractory prostate cancer: Comparing Docetaxel and Prednisone ± Bevacizumab.

• Hormone Therapy

  Testosterone is the main ingredient in cancer cell growth, so hormone therapy stops or reduces the release of testosterone. The majority of prostate cancer cells are stopped by hormone therapy, but some are unaffected. The cancer cells not effected by hormone therapy continue to grow and eventually take over the tumor. When this happens hormone therapy is no longer effective.

• Cryotherapy

  In cryotherapy a probe is inserted into the prostate and argon gas or liquid nitrogen is pumped in to freeze the prostate cells. Although advances have been made in cryotherapy, it still has a relatively high incidence of impotence and incontinence side effects.

• High-Intensity Focused Ultrasound

  High intensity focused ultrasound is an experimental technique which kills prostate cells with high heat generated by sound waves.