Treatment Options.
Your prognosis and treatment options depend on many things including your age and overall health, PSA level and the grade and stage of your cancer. The grade of cancer is an assessment of its aggressiveness. The stage is a measure of how far it has spread.
If you have been diagnosed with prostate cancer, your doctor or urologist should have told you about all the options open to you. However, we know from experience that many newly diagnosed men are not given as much detail as they need in order to make a decision about which path to follow. Below describes the most common treatments but drop into The Prostate Centre to speak to one of our volunteer retired medical professionals. Our job here at the Centre is to provide the newly diagnosed man and his family with as much unbiased medical information needed to make the best treatment decision for himself.
ACTIVE SURVEILLANCE
Prostate cancer tends to be a slow growing disease and treatments do have side effects. Therefore, in some cases, it may be reasonable and safe to wait and carefully monitor the cancer’s progress before deciding to start treatment. This process is called “watchful waiting”. In general, only men with low-stage and low-grade tumours should consider watchful waiting.
SURGERY
A radical prostatectomy is the surgical removal of the entire prostate gland and the surrounding tissues. It is the “gold standard” for treatment of disease believed to be contained within the prostatic capsule. There are several reasons for this. When cancer is confined to the prostate, surgery completely removes it. In men with low risk disease, that is to say localized cancer, low grade, and an initial PSA of less than 10, the likelihood of a cure with radical prostatectomy is as high as 95%.
WHAT TO EXPECT FOLLOWING THE SURGERY
Please click here to download a copy of the Radical Prostatectomy booklet for complete information.
RADIATION THERAPY
Radiation therapy, also called “radiotherapy” uses high-energy rays to kill cancer cells. Radiation works by damaging the cells so that they eventually die. If the cancer has a low stage with a low PSA value and a low Gleason score radiation can be as curative as the surgery. That is to say a 95% cure rate.
There are two ways in which high-energy rays can be delivered. These are external beam radiation or a type of internal radiation called brachytherapy (implantation of radioactive seeds).
EXTERNAL BEAM RADIATION THERAPY (EBRT)
With this therapy, machines focus radiation beams that go through the body from the outside. In Victoria, we use 3-dimensional conformal radiation therapy (3D-CRT).
3-DIMENSIONAL CONFORMAL RADIATION
The goal of 3D-CRT is to have the prescribed radiation dose conform to the shape of the area being treated so that there will be equal distribution of the radiation dose within that specific target.
The procedure employs the use of a CT scan to create a 3-dimensional representation or map of the tumor and surrounding area. This map, along with sophisticated treatment planning software, allows the radiation oncologist to devise a treatment plan that accurately delivers high-energy radiation to the target area, while minimizing damage to the healthy surrounding tissues.
Treatment is given 5 times each week (Monday through Friday) for approximately 7 weeks. The delivery of the radiation takes only a few minutes and is completely painless.
BRACYTHERAPY
Brachytherapy is a form of radiation therapy where radioactive seeds are inserted directly into or adjacent to the tumors. This procedure reduces the amount of normal tissue outside the prostate that is exposed to radiation. It also allows for the delivery of a higher dose of radiation to the prostate than external beam radiation therapy. It is suitable for men with organ-confined disease (i.e. Stage T1 or T2.) The PSA must be less than 15, with a Gleason score of less than 6, or a PSA less than 10 and a Gleason score of 7. The prostate must be small to moderate size. Sometimes, hormonal therapy is used prior to brachytherapy to downsize the gland. There are no age restrictions for brachytherapy but the candidate must be able to withstand a general anaesthetic. The preparatory work for brachytherapy is done in Victoria, but the man must go to Vancouver for the actual implantation.
HORMONE THERAPY
Prostate cells grow and divide under the influence of testosterone. Testosterone is mostly produced by the testicles but approximately 5% is produced by the adrenal glands. When a man has prostate cancer, testosterone stimulates the growth of the cancer cells.
Hormone therapy either uses drugs to stop the testes from producing testosterone (LHRH analogs) or it involves surgery to remove the testicles, which produce the bulk of the testosterone. The adrenal glands cannot be “shut down” but there are drugs called ‘anti-androgens’ that are given to block the effects of the testosterone on the prostate cancer cells. Often both LHRH analogs and anti-androgens are used.
When testosterone production is stopped, the effects are dramatic: the PSA falls, the tumors shrink and symptoms abate.
In men with advanced prostate cancer, this form of therapy is effective in helping to slow the growth of the tumors and thus prolong life.
Surgeons sometimes use hormonal therapy prior to radical prostatectomy to downsize the tumor.
Depending on the initial PSA, stage and Gleason score radiologists may use hormonal blockade prior to radiation to shrink the prostate and therefore reduce the size of the radiation field. They also use the hormonal therapy to drive the PSA down. Research shows that men with locally advanced disease get much better results if the PSA is driven down to below 0.1 or lower prior to the radiation. It can take eight or nine months to get the PSA to this level. Once the man’s PSA reaches the lowest point that it will go he will receive his radiation treatments.
