Prostate Cancer: Know Your Options

Fall 2006 CSANews Issue 60  |  Posted date : May 30, 2007.Back to list

In Canada, prostate cancer is the most-often diagnosed cancer in men; approximately one in seven will be diagnosed during their lifetime. Fortunately due to awareness and PSA screening, more patients are being diagnosed with lower-risk disease when cure is still possible.

After the shock of a prostate cancer diagnosis, patients must choose a treatment. This can be a difficult decision. It is made more difficult by the fact that even the experts do not always agree which treatment is best. A patient may see several physicians and end up with different treatment recommendations. How can this be? Is one physician right and the other wrong? The problem is that there are almost no clinical trials that compare different prostate cancer treatments. This, however, has not been for lack of effort. Men are very reluctant to enter clinical trials comparing prostate cancer therapies – so much so, that clear answers have not yet emerged from research comparing treatments. Physicians can only compare clinical trails that looked at only one treatment. Unfortunately, this does not lead to concrete answers.

The following is a list of the most common definitive treatments. I make no attempt to compare them but, rather, just explain what they are. My goal is to help patients get through the first step in the treatmentdecision process – becoming aware of all options available to them.

Radical Prostatectomy
The prostate is surgically removed during an operation that takes between one and three hours. Usually a patient spends two to three days in the hospital after radical prostatectomy and returns to normal daily life within a few weeks.

Robotic Radical Prostatectomy
Robotic radical prostatectomy uses a robotic surgical system to remove the prostate. This allows for a single large incision to be replaced by a few small ones, each approximately the size of a nickel. Cameras and surgical tools are guided to the prostate and the surgeon operates the equipment from a control station. This procedure takes from two to five hours. A patient will usually spend one night in the hospital and will return to daily life within about a week.

Cryoablation
Cryoablation is a minimally invasive treatment that destroys the prostate while still in the body. This is done by placing thin freezing probes called‘cryoprobes’ inside the gland. The prostate is frozen, but not removed. It takes between one and 2.5 hours, with the patient usually returning home either the same day or after one night in hospital. Typically, return to daily life occurs within two weeks.

Beam Radiation
When a beam of radiation passes through the body, some of it will be absorbed, resulting in tissue damage. During beam radiation therapy, beams of radiation are aimed at the prostate from several different angles, resulting in treatment of the prostate and minimal damage to surrounding tissue. The treatment is performed over several weeks – a little bit of radiation being given each day.

Brachytherapy
During brachytherapy, small rice-sized pieces of radioactive metal (seeds) are placed inside the prostate. Over several weeks, the amount of radiation from the seeds decreases to essentially nothing. By the time the seeds become inactive, the emitted radiation has treated the prostate. The placement of brachytherapy seeds usually takes between one and two hours, and the patient can return home the same day and return to daily life almost immediately.

High-Intensity Focused Ultrasound (HIFU)
HIFU uses focused ultrasound beams to raise the temperature of tissue to a level at which it is destroyed. HIFU is unique in that it is a non-invasive procedure involving neither radiation nor incision. It takes between one and four hours and the patient usually returns home either the same day or after a night in hospital. Return to daily life usually occurs within a week.

Patients should also ask their physicians about their individual experience with the procedure being considered, and what their outcomes have been. Most specialists track their patients and sometimes publish their outcomes in medical journals. If a specialist has done this, it will allow you to know exactly what his or her personal results are.

Being diagnosed with prostate cancer can be frightening, and choosing a treatment overwhelming. Patients should consider all options and discuss them with both your physicians and with those whom you love and trust. There are no wrong decisions if you are informed and choose what is best for you.

The following are some online sources of information that may be helpful:

Canadian Prostate Cancer Network: www.cpcn.org
Prostaid: www.prostaid.org
UsToo: www.ustoo.org
Urology Health: www.urologyhealth.org
CryoCare: www.cryocarepca.org
WorldClassMD: www.worldclassmd.com