How Prostate Cancer Staging And Risk Stratification Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
Localized, meaning theres no indication that the cancer has spread beyond the prostate
Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue
Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
How Do Hifu And Cryotherapy Compare For Treating Prostate Cancer
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We know that there are lots of different treatments for prostate cancer and according to the experts, most of them are pretty effective in eliminating early stage localized prostate cancer. It can be very confusing to compare all the different prostate cancer treatments and decide which one is right for you, but a lot of times it comes down to how to minimize side effects or complications that come along with treatments.
Aside from traditional treatments such as surgery and radiation, another option some men choose is called cryotherapy. As men and their loved ones explore non-invasive options for treatment,
they may come across cryotherapy and think that it is similar in some ways to HIFU. This article breaks down how the two treatments compare.
What is cryotherapy?
According to a definition by the American Cancer Society, Cryotherapy is the use of very cold temperatures to freeze and kill prostate cancer cells. Despite it sometimes being called cryosurgery, it is not actually a type of surgery.
Cryotherapy is sometimes recommended as a prostate cancer treatment option to treat early-stage prostate cancer. Typically this is not a good option if the prostate is very large.
What do HIFU and Cryotherapy have in common?
As treatments for prostate cancer, here are a few things that HIFU and Cryotherapy have in common:
What makes HIFU and Cryotherapy different?
Patient Selection And Evaluation
When PSA levels rise in the patient who has undergone radiotherapy, the optimal time for intervention is unclear. Most radiation oncologists feel that PSA levels can fluctuate within the first 18 months. Currently, there is no consensus among urologists or radiation oncologists about when to intervene. At UCLA, the practice has been to wait at least 18 months following radiation. When considering salvage therapy, the clinician needs to take into account other variables, such as preexisting medical conditions, age of the patient, and patient preference. It has been the practice at UCLA to perform a biopsy of the prostate if the PSA rises above the nadir level and there are three consecutive rises. In addition, a history, physical examination, urinalysis, and urine culture should be performed before the biopsy to evaluate the possibility of prostatitis or a lower urinary tract infection. If a biopsy is undertaken, multiple cores should be obtained and the pathologist must be informed that the patient has had previous radiation. Performing a prostate biopsy in a radiated patient should be approached in the same manner as for a nonradiated patient, and no additional complications in performing biopsies in radiated patients have been encountered.
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What Is The Follow
After three months, you will have a follow-up visit with your healthcare provider. At this time, youll have a PSA test, a blood test that checks for prostate-specific antigen, or PSA, a protein produced by the prostate gland. The PSA test is done to make sure that the treatment worked.
Your healthcare provider will monitor you and suggest a follow-up plan depending on the stage of the cancer and the potential for it to return.
A note from Cleveland Clinic
If youve been treated for prostate cancer and it has come back, your healthcare provider might suggest that you have a salvage cryoablation. Its important to have an honest discussion of the risks and benefits of the procedure and a good understanding of what to expect. Please make sure to ask questions about whatever concerns you. The goal is for you to be able to live longer and live well.
Last reviewed by a Cleveland Clinic medical professional on 08/27/2020.
How Is Yale Medicines Approach Unique
âAt Yale Medicine, we take a number of approaches that set our care apart,â says Dr. Yu. âFirst, we have a large physics staff that is essential to designing and verifying our radiation treatment plans. Second, we make it a point to evaluate new radiation technologies critically. We dont hold onto old approaches, but neither do we jump on the latest trends without seriously assessing what they will contribute.â
Third, adds Dr. Yu, we are running a growing prostate cancer research program and Yale Medicine is home to leading voices in urology, medical oncology and radiation oncology. âWere also on the forefront of MRI-guided prostate biopsy,â he says, âand, our bedrock is Yales multidisciplinary prostate cancer program, which brings together multiple insights collaboratively.â
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Cryoablation For Treatment Of Prostate Cancer
Men with prostate cancer may wish to consider cryoablation of the prostate gland as definitive curative treatment of their disease. This state-of-the art technology is readily available to men as an alternative to radiation therapy or to surgical removal of the prostate gland.
McIver physicians have treated over 300 men with cryoablation for more than a decade at St. Vincents. Our experience suggests a very low complication rate and a cure rate which is equal to radiation therapy.
Pain from the cryoablation procedure is minimal. Each patient has a suprapubic catheter placed while under anesthesia since the prostate gland swells temporarily with the lethal freeze. After several days the catheter can be clamped and urination initiated through the urethra. The suprapubic catheter is generally removed at the first post-operative office visit, 7 to 10 days after the procedure. Most patients can resume customary activity in two weeks. In addition to utilizing cryoablation for the initial treatment of prostate cancer, it is frequently used as curative treatment for individuals who have residual cancer after failure of radiation therapy.
What Are The Risks Of Cryotherapy For Prostate Cancer
As with any procedure, complications can occur. The risk of permanent erectile dysfunction is very high with cryotherapy. This makes it a better choice for men who arent as concerned about ED after treatment. Some other possible complications may include:
Bleeding and/or blood in the urine
Soreness or swelling in the region where the needles are put into the body
Freezing may affect the bladder and intestines, which can lead to pain and burning sensations
Urge to empty the bladder and bowels more often
Urinary incontinence is rare, but this may be more common if the man has had radiation therapy in the past
An abnormal connection between the rectum and bladder or urethra is a rare complication
There may be other risks depending on your condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
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What Are The Side Effects
Like all treatments, cryotherapy can cause side effects. These will affect each man differently and you may not get all of them.
The most common side effects of cryotherapy are erection and urinary problems.
Many of the side effects of cryotherapy are caused by healthy tissues being frozen and damaged. Side effects are more likely if you have already had radiotherapy or brachytherapy to your prostate. This is because they may have already damaged the area around your prostate.
Focal cryotherapy can cause the same side effects as whole-prostate cryotherapy. But some research suggests focal cryotherapy may cause less severe side effects, because a smaller area of the prostate is damaged than with whole-prostate cryotherapy.
Ask your doctor or nurse for more information about your risk of side effects. They may be able to show you results of treatments theyve carried out and put you in touch with other men whove had cryotherapy.
The most common long-term side effect of cryotherapy is difficulty getting or keeping an erection . More than three quarters of men cant get an erection after whole-prostate cryotherapy. This is because the treatment can damage the nerves that control erections. Studies suggest that more men get their erections back after focal cryotherapy, because less healthy tissue is damaged than with whole-prostate cryotherapy.
Some men find these problems improve with time, but not all men get their erections back. There are treatments that can help.
How Will I Know That The Treatment Has Been Successful
As with any other prostate cancer treatment option, the postoperative PSA blood test will be the primary indicator of a successful treatment. We will obtain a PSA level three months after the procedure, and then every six months for five years. After five years PSA monitoring is generally done annually. We expect to see the PSA come down to a level well below 0.5 ng/dl and remain at the lowest level achieved. Three successive rises in the PSA after reaching the lowest point would raise concern about residual or recurrent prostate cancer.
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Cryotherapy An Alternative Treatment To Radiation Therapy For Prostate Cancer
Cryotherapy means using extremely cold temperatures to freeze and destroy cancer cells. Also called cryoablation or cryosurgery though not actually a form of surgery cryotherapy relies on the principle that cancer cells are typically more sensitive to freezing than normal cells. So when an area affected by cancer is exposed to the very low temperatures, cancer cells die while normal cells survive the treatment. While cryotherapy can be used to treat earlier-stage prostate cancer, it isnt used as the first treatment. It is also a great option for treating prostate tumor thats resistant or recurs after radiation therapy. However, like brachytherapy, this treatment is not ideal for men with enlarged prostate glands.
Will I Need Help At Home After Cryoablation
Generally yes, but not skilled nursing assistance. How much help you may need is very dependent on your level of functioning before the procedure. You may need some assistance the first few days since this is outpatient surgery and you will need to take a number of oral medications on schedule, as well as manage your urine drainage bag. You should not have a lot of pain or discomfort, and will be able to ambulate before you leave the hospital on the day of your procedure.
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Are There Advantages To Using Cryotherapy For Prostate Cancer
There are few long-term studies on cryotherapy and prostate cancer. Some experts believe, though, that cryotherapy offers several advantages over surgery and radiation. Those advantages may be particularly noticeable in early-stage prostate cancer. For instance, cryotherapy is a less invasive procedure. It can be done using an epidural or spinal instead of general anesthesia. This may benefit older men with prostate cancer. It can also benefit men who have other conditions such as diabetes, heart disease, or lung disease.
Other advantages with cryotherapy include:
- Shorter hospital stay
- Shorter recovery period
- Much less swelling and pain than with standard surgery for prostate cancer
If needed, cryotherapy can be followed with other conventional therapies, such as radiation therapy or surgery.
One recent study followed men with prostate cancer for a period of 10 years. In that study, researchers concluded that cryotherapy might be as effective as radiation and other common treatments for prostate cancer. Cryotherapy, though, wasnt directly tested against those more established treatments.
Possible Side Effects Of Cryotherapy For Cancer
Side effects from cryotherapy tend to be more complicated on men who have already had radiation therapy for prostate cancer. If radiation therapy was the first treatment, the chances are high that you will have blood in your urine. Blood spots will appear for a few days after the procedure.
Here are other cryotherapy risks:
- Burning sensations or pain resulting from freezing close to the bladder
- Possible damage of nerves near the frozen tissues
- Erectile dysfunction is more prevalent after cryotherapy for prostate cancer than after radiation therapy
- A small percentage of people develop fistula
Also, cryotherapy is a localized treatment. It just kills cancer cells in the targeted area only. It wonât be as effective if the cancer cells have spread to the other parts of the body.
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Why Might I Need Cryotherapy For Prostate Cancer
Cryotherapy may be a good treatment option for prostate cancer treatment in the following situations:
Men with cancer in the prostate gland that hasnt spread to other parts of the body
Men who arent well enough to get radiation or procedure
When the goal isnt to cure, it may be useful for men who have cancer that has spread beyond the prostate gland and need treatment for symptoms
Sometimes its used for men who have had unsuccessful results with radiation therapy
Some experts believe cryotherapy can be helpful when the prostate cancer cells arent as sensitive to radiation.
Cryotherapy may not be recommended for men who have a very large prostate gland.
Cryotherapy is less invasive than standard procedure. It involves needles that are put in through the skin under the scrotum, called the perineum. There is less blood loss, a shorter hospital stay, faster recovery, and less pain. It can be repeated, if needed.
There may be other reasons for your healthcare provider to recommend cryotherapy.
Can Nerve Sparing For Potency Preservation Be Done With Cryoablation
Yes, but that is still considered experimental. Selective treatment of certain areas of the prostate is not the accepted standard for treatment of prostate cancer, since cancer of the prostate is considered to be a multifocal process. In general the entire gland must be treated for the best chance of a cure. To intentionally spare the area of the gland immediately adjacent to the recognized path of the nerve which mediates sexual function risks leaving some cancer untreated.
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How Often Does Impotency Occur After Cryoablation
Frequently. If preservation of potency is a major concern, then an alternative therapy should be considered. Monotherapy by radiation generally has a lower rate of impotency. Radical prostatectomy with nerve sparing technique also has a lower risk of impotency. Nerve sparing with cryoablation can be done, but is considered experimental at this time.
If I Have Cryoablation And Sometime Later Cancer Is Again Found In My Prostate Can It Be Treated
Yes. There are multiple options for retreatment if the cancer is still within the confines of the prostate gland. Cryoablation can be repeated any number of times since, unlike radiation, the effect of freezing is not cumulative. Radiation therapy by seeds or external beam can also be given after cryoablation. Surgical removal of the prostate gland is rarely considered after either cryoablation or radiation therapy.
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What Can You Expect After A Cryoablation Of The Prostate
After the procedure, your doctor will insert a catheter, or a drainage tube, to help urine leave the body. This is because its usual for the prostate to be swollen for about seven days, making it hard for you to urinate. Your healthcare provider will remove the catheter at an office visit about seven days after the procedure. Then you will be able to urinate on your own.
Where Can I Learn More
To learn more about cryotherapy, to view a video of doctors, patients and their spouses. The video is provided by Healthtronics and is not affiliated with ZERO The End of Prostate Cancer. This video is provided as an educational resource not an endorsement of treatment.
To learn more about localized disease, go to our Localized Cancer section.
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Cryotherapy For Cancer Prostate
Cryotherapy is one of the treatment options for men with early stages prostate cancer if itâs still just in the prostate glands.
Cryotherapy prostate cancer is considered more effective than standard prostatectomy and other forms of ration therapy.
The long-term effects of cryosurgery on prostate cancer are not well established. This is why it is recommended to treat cancer that is still confined in the prostate glands.
This is also the best option for men who cannot go for surgery to treat prostate cancer. Some of the conditions that can prevent you from going for radiation therapy or surgery include:
- Had many radiations in the past
Outpatient Or Inpatient Services
In most cases, Cryotherapy Los Angeles is usually outpatient basis. However, if itâs a treatment for deep tumors, you may have to stay for a night. If the therapy is performed using a large surgical incision, you need to prepare for a short hospitalization.
So, always discuss with your doctor the possibility of hospitalization after the procedure. If you are not sleeping in the hospital, plan for someone to drive you home after the procedure.