Back to Basics: Prostate Cancer and Treatment Options

Prostate cancer is the second leading cause of cancer death in American men, with lung cancer being number one. About 1 in every 7 men will be diagnosed with prostate cancer during his lifetime, and over 27,000 men die from it yearly. However, thanks to patient education and awareness, advancements in treatment options, and regular screenings and early detection, more men are surviving this disease than ever before.

Prostate Cancer Treatment Options: What you need to know.

The best advice in cancer prevention is to lead a healthy lifestyle; starting with a proper diet, getting enough exercise and staying away from risky activities such as smoking and drinking. These factors can go a long way in cancer prevention. However, the best preventative measure for prostate cancer is diligence – especially with prostate cancer screenings. I routinely counsel my patients to partner with their doctors to receive regular PSA tests every three to six months, annual digital rectal exams and repeat biopsies if there is a rise or fluctuation in PSA levels.  Despite the news floating around about the efficacy of PSA screening, it has been shown through various studies that it does truly work in diagnosing prostate cancer while it’s still early.

The question that many men have on their mind when they receive a prostate cancer diagnosis is, “Is this an automatic death sentence?”  It certainly is not. More than 2 million American men who have been diagnosed with prostate cancer at some point in their lifetime are still living today and are able to talk about their experiences with the disease. If caught early, the cancer is over 95% curable.

There are many options nowadays to treat prostate cancer – the best of which comes down to your own specific case. Factors like Gleason, PSA and DRE scores, age, health and family history need to be taken into account; with treatment being individualized according to these factors. Available prostate cancer treatment options include:

• Active surveillance – also known as watchful waiting, a patient and his doctor monitor the Gleason, PSA and DRE scores for changes and spikes that could indicate when other actions are necessary.
• External beam radiation – uses high-energy rays to destroy cancer cells or slow their growth.
• Brachytherapy – this technique uses radioactive seeds that are implanted in the prostate to gradually kill cancer cells.
• Hormone replacement therapy – this method blocks the production of androgens in the body, slowing or preventing the growth of cancer cells.  This can be combined with radiation therapy.
• Open and laparoscopic surgeries – surgical treatment options that remove the prostate entirely, thus removing the cancer.  This allows for proper diagnoses and staging of the tumor and can be followed up with radiation treatment if necessary
• Robotic prostatectomy – complete removal of the prostate gland, via the da Vinci surgical system.  This is the newest method in surgical prostate cancer treatment, and provides excellent results when coupled with an experienced surgeon.

Understandably, many men are fearful of the side effects of these treatments, making the decision to pick one option over another very difficult.  That’s why it’s important that men speak to their doctors in detail about the positives and negatives of each option and the needs for their specific case.

Two major concerns men face with surgical options are the risks of incontinence and impotence.  However, with advancements in robotic treatment options we have been able to drastically reduce these as risk factors.  With robotic surgery being a minimally invasive procedure there is less pain associated with the surgery, minimal blood loss, and recovery tends to be very quick.

Robotic surgical methods provide the best chance at long-term survival as the cancer is removed entirely from the body.  Should there be a recurrence of cancer in the surrounding tissue then the surgery can be followed up with radiation therapy.  Starting with radiation therapy before surgery makes any future surgical options much more difficult, with only a handful of surgeons able to perform what is called a “salvage robotic prostatectomy”.