A program of active surveillance has two goals:
  • To provide definitive treatment for men with localized cancers that are likely to progress; and,
  • To reduce the risk of treatment-related, quality-of-life side effects such as incontinence and impotence for men with cancers that are not likely to progress.

Active surveillance is not appropriate for every prostate cancer patient. You are typically a good candidate if you are a patient with a lower grade localized prostate cancer, a low PSA level, a low Gleason Score, and an appropriate clinical stage. Additional factors that you need to consider are your age, general health, life expectancy, psychological makeup and your family’s expectations

A typical program of active surveillance may include the following: a review of the candidate criteria described above; a discussion with your urologist regarding all possible treatment options; and, if appropriate, an active surveillance plan customized to your specific situation. The plan would typically include periodic physical exams and PSA testing as well as periodic biopsies as appropriate.

Your goal is to be able to react quickly to seek additional treatment promptly if a worsening of the cancer occurs.

Surgery

 Radical Prostatectomy
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A radical prostatectomy is the surgical removal of the entire prostate gland. Many experts tend to recommend surgery when the cancer is thought to be contained within the prostate, such as in stage T1 and T2 cancers, and when the man is relatively young and healthy. During surgery, the entire prostate gland plus some surrounding tissue is removed. The surgery is almost always performed under general anesthesia. It is important to note that the experience and skill of the surgeon can be a major factor in the success of the surgery. This is true in all surgical procedures, but is particularly true with a radical prostatectomy because of the challenging location of the prostate and the critical anatomy near the prostate.

If you choose surgery, be sure that you know the experience level and skill of the surgeon. Ask about the surgeon’s training and how many prostatectomies he or she performs on a regular basis. A skilled and experienced surgeon will have performed hundreds of prostatectomies and will typically perform multiple prostatectomies each week. Also, know the hospital.

Radiationradiation1

Radiation involves the killing of cancer cells and surrounding tissues with radioactive material. Radiation therapy can be particularly appealing for men who are not good candidates for surgery because of their age, ill health or advanced disease stage. However, even for those who qualify for surgery, there may be distinct reasons why radiation is the best treatment option. After evaluating the benefits, risks and potential side effects of various local treatment options, some men may decide that some form of radiation therapy is the best treatment option for them.

There are two major categories of radiation therapy:

  • External beam radiation, which is a non-invasive procedure in which high-intensity beams of radiation are directed at the target area; and
  • brachytherapy, which involves the implantation of radioactive metal seeds or pellets into the prostate either permanently or temporarily.

Based on the most recent data, cure rates appear to be similar to those of radical prostatectomy in patients with low-grade and low-stage

localized prostate cancer. In more advanced disease, radiation is sometimes used to treat a wider area surrounding the prostate and to include irradiation of regional lymph nodes, to destroy locally advanced cancer.

Cryotherapy

Cryotherapy involves the destruction of the prostate tissue by a freezing process in which the entire prostate is turned into an “iceball.” Probes containing liquid nitrogen or freezing argon gas are inserted into the prostate, causing cancer cells within the prostate to be destroyed as they thaw. Ultrasound imaging is used to ensure that the entire prostate has been frozen. The urethra is heated during the process so that it won’t be destroyed during the freezing process.

Cryotherapy requires less time in the hospital than some other treatments and is less invasive than radical prostatectomy. However, erectile dysfunction, urinary problems and rectal damage may occur. There is not a large volume of data on the long-term effectiveness of cryotherapy.

Hormonal Therapy

Most prostate cancer cells thrive on male hormones (androgens) such as testosterone. Androgens provide fuel to the fire of prostate cancer cell growth. Hormonal (or hormone-suppression) therapy is designed to turn off the production of the male hormones, or androgens.

If prostate cancer is diagnosed at an advanced stage (when it has spread beyond the prostate) or if the cancer returns after localized therapy such as surgery or radiation, additional treatment with hormonal therapy is typically initiated.

Recent studies have also shown that hormonal therapy, initiated prior to and following radiation therapy, may be more beneficial than radiation alone.