02/28/2019

Understanding prostate cancer treatment options

Men have more options than ever to treat prostate cancer. Learn more about:

Active Surveillance
Surgery
Radiation
Chemo and Hormone Therapy

Prostate cancer is the most common cancer discovered in men, after skin cancer. The good news is that it can often be treated successfully and there are a wide range of treatment options.

About one man out of every nine will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society. The average age of diagnosis is 66.

While prostate cancer is the second leading cause of cancer death in American men – behind lung cancer – only about 1 man out of 41 die from the disease. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today, the ACS reports.

Dr. John Pablo
Dr. John Pablo, radiation oncologist and medical director of the LCRP Radiation Oncology Center

Related Article: Five things men should know about a prostate exam

At the Nancy N. and J.C. Lewis Cancer & Research Pavilion, a multi-disciplinary team of urologists, medical oncologists, radiation oncologists, nurses and others gather together at Tumor Conference to review certain patient cases.

A unique thing about prostate cancer is the number of treatment options now available. Which treatment is recommended depends upon the “risk category” to which a patient falls in, says Dr. John Pablo, radiation oncologist and medical director of the LCRP Radiation Oncology Center. Contributing factors include: age, overall health, especially bladder/prostate health as it pertains to urinary function, and stage of cancer.

“It’s important for patients to discuss their treatment options with urologists and radiation oncologists so as to determine the best customized treatment plan,” Dr. Pablo says.

The majority of prostate cancer patients are good candidates for either surgery or radiation. However, it’s important to remember each case is individualized. Let’s take a look at some of the prostate cancer treatment options.

Active Surveillance

Because prostate cancer often grows very slowly, some men may opt for active surveillance. This is a common option of older men or those with other serious health problems.

Active surveillance closely monitors a man’s prostate health. How this is done can vary from physician to physician but typically requires more frequent prostate-specific antigen (PSA) blood testing and digital rectal exams. Prostate biopsies also may be done more frequently.

Active surveillance is not a good option for select younger men, those with an aggressive cancer (which is determined by a Gleason score) or those whose cancer has spread outside the prostate.

Surgery

Urologist Dr. Stephen Michigan with Urological Associates of Savannah has been treating prostate cancer for almost 40 years and has seen real advancements in treatment options, especially for advanced stages.

Dr. Stephen Michigan
Dr. Stephen Michigan, urologist with Urological Associates of Savannah

Surgery is the most common treatment option for early-stage prostate cancers, with radiation therapy a close second, Dr. Michigan says.

The main type of surgery for prostate cancer is a radical prostatectomy, in which the entire prostate gland plus some of the surrounding tissue is removed. The most common way to perform a prostatectomy is robotically.

At St. Joseph’s/Candler, surgeons use the da Vinci Surgical System to perform prostatectomies. Instead of a long cut down the abdomen required of open surgery, surgeons make six to seven smaller incisions to access the internal anatomy and remove the cancer.

Dr. Michigan says at least 90 percent of all prostate cancer surgeries are done robotically. There are a small minority of patients that are not good candidates for robotic surgery and still require an open surgery.

Robotic surgery has its benefits including quicker recovery, less pain medicine, less blood loss and shorter hospital stays. However, robotic and open prostatectomies are comparable as far as eradicating cancer, Dr. Michigan says.

Some side effects are possible following a prostatectomy, including urinary incontinence and erectile dysfunction. These conditions may slow or go away after a few weeks or months. There are treatment options if a patient experiences either of these side effects. 

Radiation

Radiation, which uses high energy rays to kill cancer cells, is a treatment option in several scenarios for prostate cancer patients. 

The goal of surgery is to completely remove all cancer from the prostate, and for men with early stage cancer, surgery is usually the only treatment they need, Dr. Michigan says. However, if the cancer is not completely removed or reoccurs, radiation therapy may be given.

If this is the case, most patients will undergo radiation therapy via the TrueBeam device, which delivers standard fractionation or moderately hypo-fractionated radiation, explains Dr. Pablo. The number of radiation treatments can range between 28 to 44.

Radiation therapy also can be used as the first line of defense against prostate cancer. Rather than surgery, some prostate cancer patients are good candidates for and opt to be treated via the CyberKnife. These patients are typically in the “low” or “favorable intermediate risk categories,” including lower PSA and Gleason scores, Dr. Pablo says.

Related Article: Lifelong law enforcement agent becomes first prostate cancer patient to be treated with CyberKnife

CyberKnife is a dedicated radiation treatment machine to give ultra hypo-fractionated radiation treatments to various cancers, Dr. Pablo says. The radiation delivered by the CyberKnife machines is extremely precise, while adjusting for any motion of the prostate during the treatment. Because of the high, but safe, dose prostate cancer patients are treated in just five sessions, either daily or every other day, Dr. Pablo says.

“Radiation treatments have been a safe and effective way to treat prostate cancer,” Dr. Pablo says. “It is important for patients to understand that there are expected and potential side effects from treatment, which have been minimized by the technology of the TrueBeam and CyberKnife machines.”

Some potential side effects could include bowel and urinary problems, impotence and fatigue.

Chemotherapy and Hormone Therapy

In the event surgery or radiation therapy doesn’t work, your medical team will determine what additional treatment is needed.

Chemotherapy is not a standard treatment option for early stage prostate cancer; however, it may be required in advances stages, especially if the cancer has spread outside the gland. Chemotherapy also may be recommended if hormone therapy isn’t working.

Hormone therapy is recommended in hopes of reducing the levels of male hormones in the body or stop them from affecting prostate cancer cells. Hormone therapy is often used if the cancer has spread too far to be cured by surgery or radiation; if the cancer recurs; along with radiation therapy if there is a high risk of recurrence; or before radiation to try to shrink the cancer to make treatment more effective.

“Surgery for early-stage prostate cancer has been successful for many years and radiation has come a long way over the last 15 or 20 years specifically because of technology,” Dr. Michigan says. “Even with advanced disease, there have been real improvements.”

 

Also in this series:

  • St. Joseph's Hospital Campus: 11705 Mercy Blvd., Savannah, GA 31419, (p) 912-819-4100
  • Candler Hospital Campus: 5353 Reynolds St., Savannah, GA 31405, (p) 912-819-6000
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St.Joseph's Hospital Campus: 912-819-4100

Candler Hospital Campus: 912-819-6000