Advances in prostate cancer treatment

March 10, 2011 By Joshua Stein, M.D.

Because prostate cancer grows slowly, some men may be able to defer treatment. With low-risk cancer that does not pose an immediate threat to a patient's health, the doctor might opt for “active surveillance.” Also called “watchful waiting,” this approach involves closely monitoring the cancer using blood tests, periodic biopsies, ultrasounds and other tests.

If treatment is required, the doctor and patient will determine the best approach, taking into account the patient's age, overall health, stage of the cancer and other factors. Treatments may include:

Radical retropubic prostatectomy – Over the years, this has been the most common technique for removing the prostate gland and surrounding tissues. The prostate gland is located behind the pubic arch (retropubically), so the surgeon makes an incision in the lower abdomen to reach it. First, however, the surgeon will usually remove lymph nodes near the bladder and have them examined for cancer. If cancer is found, the surgeon may not continue, because prostatectomy is not an appropriate procedure for cancer that has spread beyond the prostate. If no cancer is found in the lymph nodes, the surgeon will remove the prostate.

Robotic prostatectomy – For this procedure, the surgeon sits at a console near the operating table and uses robotic arms to access and remove the prostate gland and other tissues. Among the advantages: Several small incisions are made vs. one larger one, and the robotic arms can access hard-to-reach areas. In addition, studies suggest patients who undergo a robotic prostatectomy may experience less blood loss, less post-operative pain, a faster return of urinary continence following surgery and better sexual function than patients who have other prostate cancer procedures.

External beam radiation therapy – With EBRT, a device outside the body delivers high-energy X-rays to target cancer cells while sparing healthy, surrounding tissues. Different types of EBRT can be used to accurately pinpoint the size, shape and position of a prostate tumor and adjust the radiation dosage for different parts of the tumor.

Brachytherapy – Unlike EBRT, brachytherapy involves placing radiation inside the body to destroy cancerous tissue. The doctor implants tiny radioactive seeds (about the size of rice grains) in or near the tumor. The seeds are left and after several weeks or months, their radioactivity level diminishes to nothing. Brachytherapy is a minimally invasive procedure that allows the physician to use a higher total dose of radiation to treat a smaller area in a shorter period of time than with external radiation treatment.
If you have prostate cancer, you have a number of options for treatment. Talk with your doctor and find out what's best for you.

Joshua Stein, M.D., is a urologist at The Hospital of Central Connecticut. For information on Hospital of Central Connecticut physicians, please contact our free Need-A-Physician referral service by phone 800.321.6244 or online, www.thocc.org.