Treatment Options For Localized Or Locally Advanced Prostate Cancer
A man diagnosed with localized or locally advanced prostate cancer has 3 major treatment options: Active Surveillance, surgery, and radiation therapy. For patients whose cancer appears more aggressive, combination treatment may be recommended. For example, radiation therapy may be combined with hormone therapy, and surgery may be followed by radiation, sometimes with the addition of hormone therapy.
Choosing the best treatment for localized or locally advanced prostate cancer is generally based on age, the stage and grade of the cancer, the patients general health, and an evaluation of the risks and benefits of each therapy option.
Health care providers think about localized or locally advanced prostate cancer in terms of risk groups, which are assigned before the patient undergoes any treatment. There are 3 general risk groups based on the PSA, DRE, and biopsy, which can further be subdivided to better personalize treatment for each patient.
Learn more about Risk Groups.
The treatment options for each risk group have some differences ask your doctor which risk group you belong to so you can better understand the most appropriate next steps. Deciding between radiation and surgery? Dr. Dan Spratt offers 4 things to consider as you make your choice.
If I Choose Radiation Therapy Will Surgical Treatment Still Be An Option
If radiation therapy is used as the primary treatment, and the treatment is not successful, surgery or repeat radiation therapy are not considered to be desirable treatments due to the high risk of serious complications. It is important to note that the cure rates for surgery and radiation are similar. Therefore, you may have the same risk of cancer recurring if surgery is performed. If surgery is performed after radiation, or additional radiation is recommended, the physician performing the re-treatment should have a high level of experience. There are experimental clinical studies being evaluated for use of very localized re-irradiation for this group of patients. Some patients for which radiation is not effective are treated by systemic therapy or by close surveillance.
Faq: Radiation Therapy For Prostate Cancer
Why would I choose radiation therapy?
Radiation therapy, including external beam radiation therapy and brachytherapy, is an alternative form of treatment for prostate cancer. EBRT may be used after other treatments, such as surgery, to manage cancer that has recurred or is at high risk of recurrence. Radiation therapy has an excellent record of success, providing long-term disease control and survival rates equivalent to other treatments, including surgery.
How should I expect to feel during radiation therapy?
Undergoing external beam radiation therapy is similar to having a routine X-ray. Radiation cannot be seen, smelled or felt. Generally, side effects don’t appear until the second or third week of treatment. Because radiation therapy is a local treatment, only the areas of the body where it is directed will experience side effects. Most patients will experience some or all of the following:
- Increase in the frequency of urination
- Urinary urgency
- Softer and smaller volume bowel movements
- Increased frequency of bowel movements
- Worsening of hemorrhoids or rectal irritation with occasional scant blood and fatigue
Many questions may arise during radiation therapy treatment. Your doctors will be available to answer questions throughout your treatment.
How should I expect to feel after radiation therapy?
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Proton Beam Radiation Therapy
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.
How Is Prostate Cancer Staged
Prostate cancer is one of the most common types of cancer that develops in men and is the second leading cause of cancer deaths in American men, behind lung cancer and just ahead of colorectal cancer. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations.
The prostate gland is a walnut-sized gland present only in men, found in the pelvis below the bladder. The prostate gland wraps around the urethra and lies in front of the rectum. The prostate gland secretes part of the liquid portion of the semen, or seminal fluid, which carries sperm made by the testes. The fluid is essential to reproduction.
The term to stage a cancer means to describe the evident extent of the cancer in the body at the time that the cancer is first diagnosed.
- Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies.
- The stage of a cancer helps doctors understand the extent of the cancer and plan cancer treatment.
- Knowing the overall results of the different treatments of similarly staged prostate cancers can help the doctor and patient make important decisions about choices of treatment to recommend or to accept.
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Surgery For Prostate Cancer
A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinci® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.
The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.
How To Decide Between Radiation And Surgery For Localized Prostate Cancer
If youre like most men whove been diagnosed with prostate cancer, youve been told you have early-stage, localized prostate cancer, meaning the disease hasnt spread beyond the prostate. You may have also been told that you have choices about what you want to do next.
Unless your cancer is aggressive, youve probably been presented with three treatment options: active surveillance, radiation therapy or surgery. If you arent comfortable with active surveillance, or if its not an advisable option for you, you may have to decide between radiation therapy and surgery to treat your cancer.
Many men want to know whats the best treatment for their localized prostate cancer. But its a misconception that you have only one better or safer choice. In most cases, either radiation therapy or surgery is an equally good choice when we look at long-term survival.
Weve heard of some physicians telling men of their prostate cancer diagnosis and asking them to make a treatment decision at the same appointment. But prostate cancer progresses slowly, so most men have time to think about their options and shouldnt feel pressured into making an immediate decision.
How you feel about the big three possible side effects of treatmenturinary incontinence, sexual dysfunction and bowel healthmay be the deciding factor for you.
To help you through the process of making this decision, this article covers:
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Choosing Between Radical Prostatectomy And Radiation Therapy
The main advantage of radical prostatectomy is that it is arguably a one time procedure. It takes just a few hours to completely remove the affected prostate and the patient is likely to recover fully, albeit gradually and with the monitoring of a urologist. The main disadvantage is that it is appropriate only where the cancer has not spread to other organs outside the prostate. If it has spread, then removing the prostate and leaving behind other affected organs will have no effect at all. In cases where the cancer has spread, radiation therapy may be the more reasonable choice.
Other factors that urologists and surgeons consider before suggesting either procedure include:
1. Age of the patient Radical prostatectomy is offered mostly to men under 70 years of age because they are more likely to live longer and be able to survive any long term effects of the disease.
2. The natural progression of the disease Slow progression of a non-aggressive tumor does not lend itself to surgery. This is a case that can be managed by what is called watchful waiting where the disease is monitored constantly but treatment is deferred for a while.
3. The possibility of cure The goal of radical prostatectomy is to cure the patient of prostate cancer. If for whatever reason it appears that it is unlikely that this objective will be achieved, then radiation therapy or other forms of treatment should be preferred.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.
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Side Effects Of Radiation Therapy
Compared to earlier radiation methods, these modern techniques reduce the chance of urinary and bowel problems.
With several treatment options available, your doctor will work with you to develop and oversee a treatment plan that precisely addresses your prostate cancer while minimizing the risk to surrounding tissues.
This is why it is important to choose an experienced radiation oncologist who specializes in the management of prostate cancer. High volume centers where practitioners have significant experience and treat large numbers of patients with prostate cancer may be associated with good outcomes and fewer lasting problems related to treatment. The majority of patients who undergo radiation do not have permanent effects on bowel or urinary function, and patients who develop erectile difficulty after these therapies can often be treated successfully with medications such as sildenafil or tadalafil.
Radical Prostatectomy vs. Radiation: How to Compare the Results
Making a decision about prostate cancer treatment is not easy. When considering radiation therapy or radical prostatectomy, one of your top concerns is seeking reassurance that your cancer will be cured following treatment.
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.
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Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiation Therapy
Guided by advanced imaging techniques, SBRT delivers large doses of radiation over a short period of time to a precise area. SBRT is commonly referred to by the names of the machines used to deliver the radiation. SBRT can offer some patients with localized prostate cancer the convenience of fewer treatments while maintaining treatment effectiveness and safety. SBRT may also be used to treat metastases for some patients to reduce tumor mass and potentially enhance survival.
Shorter Course Of Post
WEDNESDAY, Oct. 27, 2021
After prostate cancer surgery, men can safely undergo fewer radiation treatments at higher doses, a new clinical trial shows.
Researchers found that the shorter regimen given over five weeks, instead of seven did not raise patients odds of lasting side effects.
Safety has been a major concern because when patients have fewer radiation treatments, the daily dose needs to be higher, explained Dr. Neha Vapiwala, a radiation oncologist who was not involved in the study.
But the new findings offer level-one evidence that a shorter course can be delivered safely, said Vapiwala, a professor at the University of Pennsylvania, in Philadelphia.
Prostate cancer is a highly treatable disease. In the United States, the 10-year survival rate stands at 98%, according to the American Society for Radiation Oncology. That means the impact of treatment choices on mens quality of life is particularly critical.
A shorter course of radiation is obviously appealing for its convenience. The new study was designed to find out whether fewer treatments would come at the expense of lasting side effects.
According to lead researcher Dr. Mark Buyyounouski, Preserving quality of life was a major priority when testing the shorter treatment course. It is important for patients to know that accepting a more convenient treatment doesnt mean they have to compromise on quality of life.
More information
The American Cancer Society has more on treating prostate cancer.
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Surgery Vs Radiation For Early Prostate Cancer
Analysis of 19 studies suggests surgery has an edge in survival, but experts say each case may be different
HealthDay Reporter
TUESDAY, Dec. 15, 2015 — Men with prostate cancer that’s still confined to the organ are more likely to survive if they have surgery rather than radiation therapy, a new Canadian study suggests.
This type of “localized” prostate cancer is the most common form of the disease, accounting for about 80 percent of cases, said a team led by Dr. Robert Nam of the Odette Cancer Centre at Sunnybrook Research Institute in Toronto.
The most common treatments for localized prostate cancer are surgery and radiation therapy.
But which works best to keep the disease at bay?
To find out, Nam’s team looked over data from 19 studies that included a total of nearly 119,000 men with localized prostate cancer.
Findings from 15 of the studies showed that those who received radiation therapy were twice as likely to die from prostate cancer as those who had surgery.
Findings from 10 of the studies also showed that men who had radiation therapy were 50 percent more likely to die sooner of any cause, compared to those who had surgery.
The results of the analysis were published Dec. 14 in the journal European Urology.
But prostate cancer treatment is never a one-size-fits-all matter, he added.
“There are times when radiotherapy may be more appropriate than surgery, so it is important that a patient discusses treatment options with his clinician,” Nam said.
Prostate Cancer Treatment Options For Low
Well, if you have low-risk prostate cancer, something called watchful waiting or closed surveillance would be a very good option. Close surveillance means that you would be coming every 3 months for a check-up. We would be looking at your PSA and we would be examining you. Every other year we will make an MRI or a biopsy to make sure that the cancer is not advanced. This is for people who are compliant, they have low-risk prostate cancer, they may be older and they may have a lot of co-morbidities that w may not want them to be too aggressive.
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Summary Of Surgery Vs Radiation For Prostate Cancer
- Both surgery and radiation can be used to treat patients who have prostate cancer.
- Surgery for prostate cancer is invasive but has the benefit of potentially completely removing the cancerous cells from the body.
- Radiation is a less invasive treatment for prostate cancer and also has the advantage of being helpful for patients needing palliative care.
Locally Advanced Prostate Cancer
Locally advanced prostate cancer means the cancer has broken through the outer covering of the prostate gland into nearby tissues.
Your doctor might monitor your prostate cancer if you dont have any symptoms. This is called watchful waiting. You can start treatment if you get symptoms.
Treatment options include:
- external radiotherapy with hormone therapy
- hormone therapy on its own
- surgery
A small number of men might have surgery to remove the prostate gland. But doctors don’t often use it as a treatment for locally advanced cancer.
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