Selecting the right treatment for your prostate cancer will depend on many things, including the stage and grade of the cancer, your age, overall health and lifestyle. Unlike most cancer diagnoses, a diagnosis of a prostate cancer does not necessarily come with a clear next step. If you are diagnosed with prostate cancer, be sure to discuss the pros and cons of each type of treatment with your physician to determine the best choice for you. For a more complete overview of these possible treatment paths, please see: Prostate Cancer: Treatment or Prostate Cancer: Overview, How Is Prostate Cancer Treated.
For men with a slow growing prostate cancer that is not causing any symptoms, active surveillance (also known as watchful waiting, deferred therapy or expectant therapy) may be a prudent choice. Depending on the age and disease progression of the patient, it is possible for a man to live out his normal life span, never receiving treatment for the cancer itself. It is important to note that “active surveillance” is very different than ignoring or denying the existence of the cancer. During this time, the patient receives regular PSA and DRE exams, and potentially biopsies, to monitor the progression of the disease so that a more active treatment course can be implemented as soon as necessary. This is not appropriate for every patient. But, for some men this is the most appropriate choice.
Surgery is a common treatment path for many prostate patients.
- Prostatectomy: Surgical removal of the prostate, known as a prostatectomy or a radical prostatectomy, is done to try and cure the disease, and remove all of the cancer from your body.
- da Vinci™ Robotic-Assisted Surgery: While open and regular laparoscopic prostatectomies are still performed when necessary, many Riverside prostate cancer patients elect to have robotic-assisted laparoscopic radical prostatectomies using the da Vinci surgical robot. While not appropriate for every patient, the robotic assisted surgery allows for less blood loss, shorter hospital stays, greater preservation of sexual function and bladder control, and faster return to normal activities.
- TURP: Another type of surgery, known as a transurethral resection of the prostate (TURP), can be performed to help manage symptoms, but it does not remove the prostate or cure the cancer.
In this type of treatment, radiation is targeted on the tumor site to destroy the cancer cells while preserving the healthy surrounding tissue. The two main kinds of radiation therapy are external beam radiation and internal beam radiation, both of which can be used to treat prostate cancer. With external beam radiation, the radiation source is a machine outside of your body. With internal beam radiation, also known as brachytherapy, the radiation source is placed inside the body.
With prostate cancer internal beam radiation is carried out through the surgical implantation of radioactive seeds in the prostate. You and your physician will discuss what type of radiation, if any, is right for your treatment. To learn more about radiation therapy in cancer treatment, please see: Radiation Therapy: Using radioactivity to Kill Cancer Cells.
There are three types of radiation available for prostate patients at Riverside:
- Intensity Modulated Radiation Therpay (IMRT). IMRT is a form of external beam radiation.
- Image Guided Radiation Therapy (IGRT). IGRT is also a form of external beam radiation.
The goal of hormone therapy, also known as androgen deprivation therapy, is to try to get your body to stop producing androgens (male hormones) or to stop the hormones from getting into the cancer cells. This can be done medically, through injections of certain drugs, or surgically. Hormone therapy is often used in advanced prostate cancers to slow the growth of the tumor, but it may also be used in early stage cancers to shrink the tumor prior to surgery or radiation. For more information on hormone therapies in cancer treatment, please see: Hormone Therapy: Cancer Treatment for Certain Hormone-Sensitive Cancers.
Chemotherapy is the use of medication to kill the cancer cells. It can treat the cancer, but it cannot cure it. Depending on the particular medicine, chemotherapy may be administered through an IV or taken by mouth in pill form. Chemotherapy medications are often very strong, and the side effects can make some individuals sick and uncomfortable. Your medical oncologist will work closely with you to prescribe other medications that can help you through your treatment.
Treatment Side Effects
Many men are frightened of the possible side effects of prostate cancer treatment. Both the cancer itself, as well as the various therapies, can cause incontinence (lack of control of urine) or impotence (lack of sexual function). While most patients experience both incontinence and impotence immediately following treatment, both urinary and sexual function can be improved in the weeks and months that follow. Some improvement comes with time, but physical therapy and medications can also help. Speak with the Patient Navigator or your physician to learn if a referral to the physical therapy program is right for you. For an overview of different side effects, see: Prostate Cancer Foundation: Side Effects.
Research and Clinical Trials
Ongoing research and access to clinical trials is an important component of any cancer program. Clinical trials are special research studies that look at new, sometimes experimental, treatment methods. To learn more about our Research Department and the Clinical Trials that are currently open, please visit the Peninsula Cancer Institute.
National Comprehensive Cancer Network (NCCN) Guidelines
The NCCN develops the nationally accepted gold standard guidelines for cancer treatment depending on the type and stage of the cancer. Riverside is proud to be one of the few institutions in the nation whose Cancer Registry checks 100% of our cancer cases against NCCN guidelines.
Case Conferences / Tumor Board
A case conference or tumor board is a unique opportunity to have an interdisciplinary team of physicians and other health care specialists discuss your case and treatment plan. As an accredited Comprehensive Community Cancer Program by the American College of Surgeons’ Commission on Cancer, Riverside’s cancer program reviews a minimum of 10% of all cancer cases in a case conference or tumor board setting. Pathologists, radiologists, surgeons, medical oncologists, radiation oncologists, patient navigators, nurses and other specialists discuss the specifics of the case, and often review the latest research that may apply to it. The benefit to the patient is the opportunity to have more physicians reviewing the case – like getting a second, third and fourth opinion all at once.
For more information on our Prostate Cancer Program, please see our 2005 Cancer Services Annual Report, which includes a section highlighting prostate cancer care at Riverside.