Prostate Cancer Treatment Options
There are multiple options for prostate cancer treatment. Each option has both benefits and risks. There are also clinical and personal factors that must be considered. Dr. Gapin will work closely with you to help determine the best treatment option.
Treatment options for prostate cancer include:
Active surveillance (formerly called “watchful waiting”) is an option for men who decide to not undergo immediate surgery or other treatment. Your doctor will actively follow the cancer, but will avoid actual treatment. Treatment will only be initiated if the cancer shows signs of progression. This option requires an MRI and targeted biopsy to ensure accurate staging. It is only indicated for clinically insignificant cancers. Close routine follow-up and periodic, careful monitoring are required to identify any signs of progression. The tests required include a PSA every 3 months, MRI every 6-12 months and a repeat MRI-guided targeted biopsy every year.
Surgery (Radical Prostatectomy)
Robotic prostatectomy is a surgical option for treating clinically significant prostate cancer. This involves removing the prostate through five ‘keyhole’ incisions in the lower abdomen. Patients typically have a 1-2 day hospital stay and experience minimal pain. This is an excellent option in terms of long-term oncologic outcomes, but comes with its fair share of risks, including urinary incontinence, erectile dysfunction, and loss of ejaculate.
Brachytherapy involves placing tiny “seeds” of radioactive iodine or palladium into the prostate with needles through theperineum (space under the scrotum) using transrectal ultrasound guidance. This option is performed in tandem by a radiation oncologist and urologist.
Another form of radiation therapy is external beam radiation, or IMRT (Intensity-Modulated Radiation Therapy). With this option, approximately 40 treatments are administered over 8 weeks (Monday-Friday), with each treatment lasting 12-15 minutes.
For moderate and high risk disease, patients areoften given hormone therapy for 6 months to 2 years in conjunction with radiation treatments. This is because research shows better oncologicoutcomes using this additional therapy during treatment.
HIFU, or High Intensity Focused Ultrasound, is a precise, non-invasive therapy for the treatment of localized prostate cancer. This ablative therapy uses controlled thermal energy delivered through a rectal ultrasound probe to precisely destroy prostate cancer tissue while minimizing treatment-related side effects. There have been over 50,000 cases performed throughout the world since 1998 and more than 7,000 men in the U.S. have travelled abroad to receive HIFU treatment prior to its FDA clearance. This outpatient procedure takes 2-3 hour and is performed in a hospital or surgery center under general anesthesia. HIFU offers excellent oncologic outcomes that are comparable to surgery and radiation. There is also minimal associated risk of urinary incontinence, erectile dysfunction, or loss of ejaculate.
Cryosurgery, also known as cryotherapy or cryoablation is a minimally invasive ablative therapy for the treatment of prostate cancer. During cryosurgery, metal probes are placed through the perineum (the area between the scrotum and anus) to freeze areas of the prostate using ultrasound guidance. This 2-3 hour outpatient procedure is performed in a hospital or surgery center under general anesthesia. Cryosurgery offers men good oncologic outcomes, however, there is significant risk of erectile dysfunction, incontinence, and damage to surrounding structures including the retum.
Focal, or targeted therapy is a minimally invasive outpatient procedure where only limited areas of the prostate that have cancer are treated. This option can be performed using HIFU or cryosurgery. It is ideal for patients with unilateral, early stage, low volume cancer as well as for patients that want to minimize treatment-related side effects. Advanced diagnostics using MRI and MRI-guided targeted biopsy are critical for patient selection. Focal therapy offers men excellent oncologic outcomes with minimal side effects including a low risk of incontinence, erectile dysfunction, or loss of ejaculate.
Innovations in Prostate Cancer Treatment
Learn the latest in prostate cancer diagnosis and treatment including HIFU during a four-part interview with Dr. Gapin, patient Dan Avery and host Heidi Godman of Sarasota Talk Radio.