Wednesday, February 1, 2023

Is Surgery Best Option For Prostate Cancer

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Expert Review And References

Robotic surgery for prostate cancer: what are the benefits?
  • American Cancer Society. Treating Prostate Cancer. 2019: .
  • American Society of Clinical Oncology. Prostate Cancer. 2020: .
  • Tracy, CR. Prostate Cancer. eMedicine/Medscape 2020: .
  • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
  • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
  • National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer . 2020 .
  • Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenbergs Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer 2019: 70: 1087-1136.
  • Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up . Annals of Oncology . 2020 : 31: 1119-1134 .

Prostate Cancer Survival Rates

Answering the question of how curable is prostate cancer? first requires understanding what doctors mean when they refer to curability. Regardless of the type of cancer, doctors consider cancer cured when a patient remains cancer-free for a specified period after treatment. The higher the number of patients who stay cancer-free for five years or longer, the higher the curability of that particular disease.

Prostate cancer, therefore, has one of the highest curability rates of all types of cancer, thanks in large part to early detection standards and advances in treatment, such as the stereotactic body radiation therapy offered by Pasadena CyberKnife. When the cancer is detected in the early local or regional stages that is, before the cancer has spread or when it has only spread to limited areas in the pelvic regions the five-year survival rate is nearly 100 percent.

Survival rates decline significantly when cancer is detected at later stages however, the good news is that only about five percent of men are diagnosed after the cancer has become widespread throughout the body. In short, more than 90 percent of men who are diagnosed with prostate cancer live for five years or longer after treatment, making it one of the most curable forms of cancer.

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Treatment By Stage Of Prostate Cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.

Early-stage prostate cancer

Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.

ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.

Locally advanced prostate cancer

Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.

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The Gold Standard Of Care

The gold standard of care for prostate cancer begins with the patient and his support person talking with the experts the surgeon , a radiation oncologist and a specialist nurse. In doing so, the man is provided with the relevant information and impartial advice he needs to make an informed decision about his preferred treatment.

Virtually all specialist doctors who treat cancer profess to be part of a multi-disciplinary team, that includes surgeons, medical and radiation oncologists and other experts, and attend meetings where the relevant health professionals discuss patient cases to decide on management. These team meetings are valuable, but they are only one aspect of a high quality service. Meetings do not include the patient, the man with prostate cancer, who is integral to the .

The multi-disciplinary team model has been successful in the treatment of breast cancer. There is nearly always more than one good treatment option available for men with prostate cancer, sometimes several. For men with low risk cancers, many may not require active treatment up front and are appropriately managed by active surveillance or careful monitoring.

Treatment Options For Prostate Cancer

Is Surgery the Only Option for Treating Prostate Cancer? » Kanser ...

There are a number of different treatments for prostate cancer. You may have a choice of treatments such as surgery or radiotherapy. Or your doctor might suggest that you have monitoring of your cancer instead of treatment straight away. Your doctor will recommend the best treatment for you.

This page is about treatment for people who have prostate cancer that hasnt spread to other parts of the body. We also have information about treatment for people who have prostate cancer that has spread to other parts of the body. This is metastatic or advanced prostate cancer.

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Advantages And Disadvantages Of Prostate Surgery

Advantages

  • Surgery will completely remove the cancer if it is only in the prostate gland.
  • The prostate can be removed and be fully analysed and staged in the laboratory.
  • The success of the treatment can be easily assessed by PSA testing.
  • If the PSA were to rise after surgery you would still be able to get other treatments like radiotherapy or hormone treatment.

Disadvantages

It involves a general anaesthetic and the usual risks you would expect with surgery, like the risk of bleeding, infection and blood clots.

  • You will have to stay in hospital for a few days.
  • You may get side-effects afterwards like problems with erections and urinary incontinence.
  • Recovery takes around 6 weeks.

Most Prostate Surgeries Are Now Done Robotically

In the U.S., about 95% of prostate surgeries are performed robotically, with the surgeon sitting apart from the patient at a control console, watching progress on a high-definition monitor while controlling the robot remotely. The robot translates the surgeons hand movements into precise micro-movements, making it easy for them to manipulate a tiny camera and surgical instruments with greater range of motion than they could with their hands.

Robotic procedures are done with the patient under general anesthesia and take two hours or more to complete. The possibility of side effects is a concern with any type of prostatectomyeven with the aid of a robotthe main ones being an inability to control urine after surgery, and difficulty having or maintaining an erection. There are several different types of robotic surgeries, and each one comes with its own set of benefits.

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What Is The Best Option For Prostate Cancer Surgery Or Radiation Topic Guide

Side Effects Of Radiation For Prostate Cancer

Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

The primary potential side effects of radiation treatment for prostate cancer include bowel problems, urinary problems and sexual function issues.

According to patient-reported outcomes measuring quality of life from men who participated in the 10-year, randomized Prostate Testing for Cancer and Treatment trial, men who were treated with radiation reported little increase in urinary leakage after radiation therapy. They also reported less sexual dysfunction when compared to men who were treated with surgery. However, men treated with radiation reported a higher incidence of bowel problems, such as loose and bloody stools. These side effects are often short-term for most patients, but some experience long-term side effects.

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What Are Your Treatment Options For An Enlarged Prostate

Call Us 212-731-6000. Minimally invasive ablation for prostate cancer is a relatively new and evolving treatment option for prostate cancer at NYU Langones Perlmutter Cancer Center. It uses radiofrequency, high-intensity focused ultrasound , or cryotherapy to ablate, or destroy, part or all of the prostate. However, during prostate treatment, the muscles surrounding the prostate can become gradually weakened, Non-Surgical Devices that May Help. While there few surgical options that are truly effective, there is a multitude of non-medical devices available over the counter. A recent Internet search yielded multiple products designed to help. When surgical margins are positive, several studies show that immediate radiation to the prostate fossa will lower relapse rates and may slightly improve 10-year survival rates. However, since only 50% of men will relapse, waiting for evidence of a PSA rise before starting radiation may be a reasonable alternative Although non-surgical options, such as pelvic floor muscle exercises , can hasten continence recovery, patients who remain incontinent at one-year post-procedure, or have severe incontinence at six months, may elect to undergo surgicaltreatment

External Beam Radiation For Prostate Cancer

When most patients think of radiation therapy, they think of external beam radiation therapy , in which a beam of radiation is directed at cancerous tissue from outside the body. Technological advances, such as intensity-modulated radiation therapy and image-guided radiation therapy , allow radiation oncologists to use computer-controlled devices and image-guidance technology to see and target a three-dimensional image of the tumor, making the treatment more precise than ever before.

In the past, EBRT required 40-45 daily treatments. Now, 25-28 treatments are the norm. This type of protracted, fractionated radiation therapy, however, is now generally considered to be less appropriate for low-risk and favorable intermediate-risk patients. Instead, hypofractionated techniques and brachytherapy techniques are generally more advisable for many patients.

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Risks Of Prostate Surgery

The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:

  • Reactions to anesthesia
  • Blood clots in the legs or lungs
  • Damage to nearby organs
  • Infections at the surgery site.

Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.

If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.

In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.

What Should Patients Know About Msks Approach To Treating Prostate Cancer

Laparoscopic Surgery For Prostate Cancer

At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.

Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.

The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.

We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.

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How Prostate Cancer Staging And Risk Group 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.

The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:

  • Localized: Theres no indication that the cancer has spread beyond the prostate.
  • Regional: Theres evidence of cancer cells in nearby lymph nodes or tissue.
  • Distant: 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

Treatment guidelines for prostate cancer

Brachytherapy For Prostate Cancer

Brachytherapy is a form of internal radiation therapy. With this type of therapy, radiation is delivered to the prostate tumor inside the body via a catheter or another implantable device.

High-dose rate brachytherapy uses radioactive Iridium-192 to deliver high doses of radiation to the prostate tumor. Treatments are short, sometimes requiring as few as five sessions. Brachytherapy radiation more tightly surrounds the tissues were targeting, which may help spare normal tissues.

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Treatment For Cpg 1 Localised Prostate Cancer

You might not have treatment straight away. Instead, your doctor recommends monitoring your cancer closely and then discussing treatment if the cancer begins to grow. This is called active surveillance.

If you decide to have treatment, it might include:

  • surgery to remove your prostate or
  • external radiotherapy

Getting Help With Treatment Decisions

Cleveland Clinic shows progress in prostate cancer removal with improved robotic surgery

Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800-227-2345 or see Find Support Programs and Services.

Itâs important to know that each manâs experience with prostate cancer is different. Just because someone you know had a good experience with a certain type of treatment doesnât mean the same will be true for you.

You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.

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Types Of Prostate Surgery

There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.

Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.

The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.

Keyhole surgery

Keyhole surgery .

  • Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
  • Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.

Open surgery

Choosing The Best Treatment

It can be difficult to choose the best treatment for you. Your doctor and specialist nurse will explain the different treatment options and help you make a decision. The Predict Prostate tool can also help you decide between monitoring and radical treatment. We have more information about this tool further down this page.

A UK trial showed that there can be very little difference in survival between the treatments especially if you are diagnosed with early prostate cancer.

The table below shows how many men survive different treatments for CPG 1, 2 and 3 localised prostate cancer after 10 years.

Treatment

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