Prostate Cancer

The American Cancer Society estimates that in 2022 prostate cancer will be the most commonly diagnosed cancer among US men (aside from skin cancer) and the second most common cause of cancer death (after lung cancer).

It is estimated that about 1 in 8 men will be diagnosed with prostate cancer during their lifetime.

You can learn more about what the prostate gland is and how prostate cancer is diagnosed HERE.

Once prostate cancer is diagnosed, your urologist will discuss with you several options for treatment. It is imperative that you discuss your options with a urological surgeon who is familiar with all treatment options so you get a non-biased recommendation. Learn more about the treatment options for prostate cancer in this video:

What options are available?

Watchful Waiting

This approach is the least involved and refers to monitoring the cancer without getting regular tests or biopsies. It essentially allows the cancer to take on its natural course.

In 2018 a Scandinavian trial (SPCG-4) showed that compared to surgery, watchful waiting led to reduced life expectancy by 3 years. This means that patients who elected watchful waiting on average lived 3 years less than those who elected surgical treatment.

Active Surveillance

This approach is aimed at less aggressive cancers and at patients who do not wish to actively treat the disease. It does not mean no treatment at all, which differentiates it from watchful waiting. It involves routine laboratory testing and repeat biopsies to track the progression of the disease. If the disease progresses, then all treatment options can be reviewed again.

This treatment approach is often a good option for low volume Gleason 6 disease. A 2019 study out of Memorial Sloan Kettering Cancer Center showed that in carefully selected patients, active surveillance led to ~1% risk of distant metastasis.

Surgery

This is a surgical approach to the cancer that is aimed at removing the prostate gland and sometimes lymph nodes. It is best suited for localized cancer that has not yet spread outside of the organ and for patients who want the cancer removed from their bodies.

There are different approaches to this surgery including the open approach or minimally invasive laparoscopic or robotic approach.

Robotic prostatectomy is currently the gold standard for prostate cancer and in experienced hands is often the best option for treatment. Risks of surgery are bleeding, infection, and potential injury to surrounding structures. Depending on the experience of your surgeon you may experience erectile dysfunction and/or some degree of urinary incontinence after surgery.

Radiation Therapy

Radiation is a good option for patients who do not want surgery or are poor surgical candidates. It is also a good option for those who are anxious about the potential complications of surgery but radiation therapy has its own potential complications.

Radiation can be done in two ways depending on your biopsy results. External beam radiation may involve multiple rounds of radiation that is aimed at killing cancer cells from outside-in. Brachytherapy or “seeds” is a form of radiation where small radioactive pellets are placed inside your prostate with the hope of killing the cells from inside-out. Often hormonal therapy may be added to these treatments to maximize the treatment effect. This also increases side effects and may worsen quality of life.

If radiation therapy fails to control the cancer, then surgery may no longer be an option. However, if surgery is selected as a first line treatment, then no bridges are burnt, and radiation can be used if the cancer returns. Radiation therapy may also adversely affect surrounding tissues and have chronic consequences such as radiation cystitis and proctitis which are irreversible. This would lead to bleeding out of the bladder and rectum.

Cryotherapy

This approach is aimed at freezing the prostate tissue to kill cancer cells. This approach is considered experimental by some and are only effective for a subset of patients. The recurrence rate of cryotherapy is very high compared to the more traditional approaches mentioned above. In a recent study HIFU and cryotherapy showed up to about 50% recurrence rate at 5 years.

High-Intensity focused Ultrasound (HIFU)

This is an investigation treatment aimed at killing cancer cells by using sound waves. Like cryotherapy, this is in its early stages and not considered appropriate for most patients. The recurrence rate is also very high in multiple studies. In a recent study HIFU and cryotherapy showed up to about 50% recurrence rate at 5 years.

Systemic Therapy

Systemic therapy may consist of hormonal therapy, chemotherapy, or immunotherapy. This is often reserved for advanced or non-localized prostate cancers. Your surgeon will review these options with you if necessary. Hormonal therapy is sometimes added to radiation treatment but can result in worse quality of life long term.

As always, the information above is meant to be informative and does not replace your physician's recommendations or judgement. Each individual case has to be evaluated carefully to determine the best course of action. Call or use our contact page to request an appointment to further discuss your unique case.