Treatment Options

Brachytherapy

Brachytherapy involves the implantation of tiny radioactive seeds into the prostate, guided via ultrasound. The radiation emitted from the seeds effectively kills cancer cells with relatively little harm to the surrounding bladder or bowel tissue. This type of treatment is highly recommended for patients who have localized prostate cancer and who wish to avoid surgery for medical or other reasons.

Prior to implantation of the radioactive seeds, a half-hour treatment planning procedure takes place. This procedure utilizes digitized rectal ultrasound (also referred to as a volumetric assay). The ultrasound pictures are then used by the physicians and physicists to determine how many seeds will be required for the treatment as well as where to place each seed in order to ensure complete treatment of the cancer. Two to four weeks after this volumetric study has been done, the actual implantation will be performed. It is an outpatient procedure, and can be done under either general or spinal anesthesia.

At the time of the implantation, the planning staff utilizes the ultrasound technique again to project an image of the prostate onto a television screen. They position a small plastic or metal template near the body (close to the perineum) which is used to map the coordinates in order to place the seeds according to the optimized, pre-determined plan. In this way, the ultrasound directly guides how the needles, which carry the specified number of seeds, will be introduced into the prostate gland. After the implantation, the bladder is visually inspected and an x-ray is taken. The entire procedure normally takes 2-3 hours.

For some patients, a foley catheter is inserted through the urethra and placed in the bladder for 2-3 days. Your outpatient discharge will normally occur on the same day. You may be prescibed antibiotics, anti-inflammatories, analgesics, and in some cases some bladder/urethral antispasmodic medication.

Chemotherapy
Chemotherapy is a common method of treatment for other types of cancers. It is normally not used for the treatment of prostate cancer. This method involves the injection of chemical compounds into the body that kill growing cancer cells.

Cryotherapy
Cryosurgery, also known as cryotherapy or cryoablation, involves destroying the tumor by freezing the tissues of the prostate. The process is minimally invasive compared to conventional surgical techniques.

External Beam Radiation Therapy
This therapy requires the bombardment of the affected cancerous region from an external radiation source, as opposed to an internally implanted one such as in brachytherapy.

Radical Prostatectomy
This surgery involves removal of the prostate gland, seminal vesicles and pelvic lymph nodes. It also allows the surgeon to thoroughly examine the surrounding area for any spread of the cancer. In the Retropubic approach, the surgeon makes an incision in the lower abdomen and examines the area around the prostate, particularly the lymph nodes. If the lymph nodes are enlarged and involved with cancer, the surgery will be automatically stopped. If the lymph nodes appear normal, they are removed along with the prostate gland and seminal vesicles. In order to take out all of the prostate, a portion of the urethra is removed along with the prostate gland. The remaining urethra is then reconnected to the bladder. A thin rubber catheter is inserted through the penis into the bladder to drain urine and to allow the connection to heal. The catheter remains in place for 2-3 weeks. The operation usually takes 2 to 2 1/2 hours.

This method has been proven to be very successful with a long track record of treatment effectiveness.

Active Surveillance Strategy

Active Surveillance Strategy is an alternative to undergoing treatment. Its effectiveness relies upon the characteristically slow growth rate of prostate cancer. No treatment is involved; rather, patients go for checkups on a regular basis to have their condition monitored. An active surveillance program involves monitoring a man’s prostate cancer on a regular basis using several elements, including a prostate-specific antigen (PSA) test, rectal exams and periodic biopsies or MRIs of the prostate.

Second Opinion

CPCC encourages that men seek a second opinion before committing to any treatment. The 2nd Opinion helps a man decide which treatment option is best for his clinical status.