Treatment Options
What Prostate Cancer Treatments Are Available?
Patients facing a diagnosis of localized prostate cancer have multiple treatments to consider. Each treatment has its own benefits and risks, and patients and their partners must thoroughly weight these through the oversight of their physicians. Other factors may impact the treatments available to an individual patient, including PSA, quality of life issues, and lifestyle. Current treatments available to patients with prostate cancer include:
• High Intensity Focused Ultrasound (HIFU)
• Cryotherapy
• Radical prostatectomy
• Hormone therapy
• Radiation therapy
Watchful waiting, while technically not a treatment, is another option some patients choose. This involves pursuing no treatment at all, but rather using frequent testing to monitor the growth of prostate cancer. This protects patients from the impact some of these treatments have on the man’s quality of life.
IMPORTANT INFORMATION: HIFU using the Sonablate 500 has not yet received approval for use in the United States. The Sonablate 500 is still in investigational stages and is in clinical trials in the US. The FDA has not yet made a decision as to the efficacy and safety of the device for the treatment of prostate cancer. All information outlined below is for general informational purposes only and is not intended to be used in place of professional medical advice and care from a qualified physician. Please discuss your treatment options and any potential outcomes with your physician.
High Intensity Focused Ultrasound
HIFU using the Sonablate 500 gives patients access to a minimally invasive treatment option for localized prostate cancer. The treatment uses a transrectal probe to send ultrasound waves into the prostate gland. The ultrasound waves heat and destroy the tissue at specific focal points in the gland. In addition, the transducer also captures images of the gland to help guide treatment. The goal of HIFU with the Sonablate 500 is to destroy the entire prostate gland. For most patients this takes between one and four hours and is an out patient procedure. After treatment, patients wear a catheter for up to four weeks while the area heals. Most patients are up and walking within hours of HIFU treatment, returning to their normal lifestyles within a few days. Possible mild side effects include frequency, mild discomfort when urinating, discharge in the urine, and urgency. Other complications reported in studies done outside of the US include rectal fistula, incontinence, retention, urinary stricture, and erectile dysfunction.
Cryotherapy
Cryotherapy is a minimally invasive treatment that destroys the prostate gland by freezing the tissue. This procedure is sometimes called cryoablation or cryosurgery. To freeze the tissue, the physician inserts needles into the prostate and sends cold gasses through them to freeze the tissue. This is guided by ultrasound imagery to ensure proper tissue destruction. The procedure can utilize epidural, spinal, or general anesthesia. Possible complications include swelling, incontinence, rectal fistula, and erectile dysfunction.
Radical Prostatectomy
The surgical removal of the prostate gland and some of the surrounding tissue is known as a radical prostatectomy. This can be either laparoscopic or open surgery. The surgical treatment method has the longest history of use and carries the advantage of completely removing the prostate gland. The open procedure takes between two and four hours, while the laparoscopic procedure can take up to eight. Both procedures require a hospital stay. Most patients must have general anesthesia, and a catheter after the surgery must be worn to allow the body to heal.
Hormone Therapy
Androgen deprivation therapy, or hormone treatment, works on the principle that certain male hormones, like testosterone, fuel the growth of the prostatic tumors. By suppressing the levels of these hormones, prostate cancers grow more slowly, and sometimes even shrink. This is not a cure for prostate cancer, but it can be used as a palliative treatment. However, it does create quality of life issues, such as loss of muscle mass, depression, fatigue, weight gain, decreased mental acuity, anemia, and osteoporosis.
Radiation Therapy
Radiation therapy includes two treatments: External Beam Radiation Therapy (EBRT) and brachytehrapy (seed implants). For men with prostate volumes less than 60 grams, EBRT is typically recommended. This therapy involves sending radiation into the cancer from outside of the body. Brachytehrapy places radiation into the body in the form of tiny radioactive pellets that are inserted directly into the prostate, where they gradually release their radioactive properties into the gland.