Prostate Cancer

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The prostate gland is part of the male reproductive system and is located just below the bladder and in front of the rectum. It is approximately the size of a golf ball and surrounds the urethra. Its function is to supply semen for protecting and nourishing sperm. Male hormones can make the prostate grow in size, slowing or stopping the flow of urine from the bladder.

Prostate growths can be benign, where the number of prostate cells is increased (benign prostatic hyperplasia or BPH) or the size of the prostate cells have grown (hypertrophy) or the growths can be malignant.

Prostate cancer is the second most prevalent form of cancer in men after skin cancer. One in six American men will have prostate cancer during his lifetime; totaling 242,000 in the United States in 2012.

The risk of developing prostate cancer increases with age. It is more common in African American men than in white or Hispanic men. Family history may also increase risk. Researchers have recently found that changes to certain genes on your chromosomes may also be linked with higher risk. Almost nine out of ten cases are diagnosed at the early and highly treatable local stage. Most frequently, early stage prostate cancers have no symptoms. Symptoms for later stage prostate cancer include difficulty urinating, weak urine flow, urinating urgency, difficulty having an erection and blood in the urine or semen. Your doctor can check for prostate cancer using a Prostate-Specific Antigen (PSA) blood test and a digital rectal exam. Only a transrectal biopsy can confirm the diagnosis.

There is a range of treatment options that can successfully cure or manage prostate cancer. These include active surveillance, surgery, chemotherapy, hormone therapy and radiation therapy. Which one is most appropriate for you depends on variables such as your overall health, your comfort level with certain potential side effects and whether or not your cancer has recurred.

Active Surveillance

If you are diagnosed with early stage prostate cancer that is growing very slowly, you may choose active surveillance with your doctor. This option may also be appropriate if you are older (75 years+) and have other serious health problems. If you choose this option, your doctor will check you every three to six months and will continue to monitor your PSA levels. If your PSA levels start to increase or you develop other symptoms, you will move onto another approach.

Surgery

When the disease is still local and contained within the prostate, your Urologist may recommend a radical prostatectomy to cure your cancer. The entire prostate gland, as well as nearby tissue and the seminal vesicles are completely removed. The surgeon may perform the prostatectomy using one of several techniques including a traditional “open” approach that requires a long incision into the abdomen or a laparoscopic approach that accesses the gland through several smaller incisions. The da Vinci® Surgical System is used by many surgeons who prefer the minimally invasive approach.

Chemotherapy

Chemotherapy uses powerful drugs circulated in the bloodstream to control the tumor and destroy cancerous cells. It is not used as a standard treatment for early prostate cancer although some clinical studies show it may help prevent or stall a recurrence if given a short time after surgery. Like hormone therapy, chemotherapy is unlikely to cure the cancer but may slow its growth and help reduce symptoms.

Hormone therapy

Male hormones such as testosterone can cause prostate cancer to grow. Lowering hormone levels can slow down and even shrink prostate tumors. Hormone therapy can be initiated through drugs that prevent the testicles from making testosterone or by blocking the hormones from working. Hormone therapy can also be accomplished through surgery by removing the testicles. While it can’t cure the cancer, hormone therapy can help manage and control it and provide relief from certain symptoms. Hormone therapy causes side effects such as impotence and hot flashes. For this reason it is typically used for prostate cancer that has spread to other parts of the body.

Radiation Therapy

Radiation therapy can be used as the primary treatment for prostate cancer or in conjunction with other treatments such as surgery or hormone therapy. In early stage prostate cancer, studies have shown that the outcomes of surgery and radiation therapy are comparable.

Radiation therapy can be used as the primary treatment for prostate cancer or in conjunction with other treatments such as surgery or hormone therapy. In early stage prostate cancer, studies have shown that the outcomes of surgery and radiation therapy are comparable. While there are different forms of radiation therapy, only the highly targetable are used against prostate cancer since it is so important to avoid the bladder and the rectum surrounding the tumor site. One of several highly sophisticated forms of External Beam Radiation Therapy or Internal Radiation Therapy may be recommended, depending on the size and location of the tumor or tumors.

3D-Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy (IMRT)

3D-Conformal Radiation Therapy and IMRT are two forms of External Beam Radiation Therapy. During 3D-Conformal treatments, a device called a “multi-leaf collimator” will shape the individual radiation beams to “conform” to the shape of your tumor according to the data and instructions it receives from the system computer. IMRT uses thousands of radiation “beamlets” from many different angles to deliver a single dose of radiation. The intensity of the “beamlets” can change during the treatment session to modulate the dose, so that the tumor receives a very precise high dose of radiation, while minimizing damage to surrounding, normal tissue.

Before each session, a Radiation Therapist will carefully position you on the treatment table using a body immobilizer for precise body placement. Image guidance will be used to confirm the location of the tumor before the therapy begins. During your treatment sessions, the radiation delivery system will revolve around you, delivering the radiation according to the plan set by your Radiation Oncologist. Each treatment session lasts from 10 to 30 minutes. Sessions last five to eight weeks. The sessions are pain-free and require no sedation so you can return to your normal activities right away.

Stereotactic Body Radiation Therapy (SBRT)

Stereotactic Body Radiation Therapy (SBRT), another form of External Beam Radiation Therapy, effectively treats cancers in high-risk locations. It is so precisely targetable that Radiation Oncologists can use it to shrink and destroy tumors without damaging vital, nearby tissue. As you undergo therapy, the system’s imaging technology tracks the tumor in real-time and makes adjustments as you breathe, a process called respiratory gating. SBRT provides such precise targeting that Radiation Oncologists can increase the radiation dosage and deliver it over a shorter period of time.

You will typically have one to five treatment sessions rather than the standard six to eight weeks of traditional EBRT treatment. During each session, a Radiation Therapist will carefully position you on the treatment table using a full body immobilizer. Image guidance will be used to confirm the location of the tumor before the therapy begins. The sessions are pain-free and require no sedation so you can return to your normal activities right away.

Internal Radiation Therapy (Brachytherapy)

Internal Radiation Therapy, also known as Brachytherapy, targets tumors with radiation delivered through tiny catheters (tubes) that are guided into the prostate using transrectal ultrasound. Low Dose Rate (LDR) Brachytherapy radioactive seeds, the size of a rice grain, are implanted at the tumor site through the catheters. The seeds remain near the tumor. Over time, the seeds become non-radioactive. With High Dose Rate (HDR)

Brachytherapy, a computer-controlled machine sends the radioactive isotopes through tiny sealed pellets that are inserted down each catheter to deliver the radiation at multiple depths and varying times. The overall treatment time at the tumor site is 10 to 20 minutes. Your treatment plan may require one session or multiple sessions. The catheters are then removed so that no radioactive material remains in the body. You are free to resume normal activity with either treatment.

Supplemental Targeting for External Beam Radiotherapy

Calypso 4D Localization

The state-of-the-art Calypso System offers sophisticated real-time prostate tumor tracking. Subtle movements during treatment can cause the fixed radiation beam aimed at the tumor to touch surrounding healthy tissue. This can lead to incontinence, impotence and other common side effects associated with prostate radiation treatment. Used in combination with external beam radiation therapy, the Calypso system works just like the GPS in a car. It alerts your Radiation Therapist when the tumor is no longer in the treatment target zone and stops the radiation delivery. This avoids irradiating other nearby organs and minimizes unwanted side effects. Since the prostate can be targeted more accurately, the radiation margin can be diminished. This allows your oncologist to prescribe a higher dose of radiation to the prostate and minimize radiation to normal tissue.