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Prostate Cancer Treatment Options

Last Updated Monday, June 09, 2014 12:05:25 PM


Treatment Options

The most common cancer in men, prostate cancer, affects one in every six American men. Fortunately, this cancer is usually slow growing, and most tumors are found in time for effective treatment.

When prostate tumors are small and/or slow growing, specialists often use a "watchful waiting" or "active surveillance" approach. If treatment is necessary, physicians at El Camino Hospital are well versed in the latest procedures for the treatment of prostate cancer.

Active Surveillance

It can be challenging to predict the clinical outcomes for prostate tumors using traditional diagnostic techniques. As a result, some men end up having unnecessary surgery or radiation with potential side effects. Active surveillance is a method of monitoring low- risk prostate cancer in patients who may not require surgery or radiation. The physician decides if a patient is a candidate by looking at the parameters of his tumor and discussing the pros and cons of treatment with the patient.

The key to successful active surveillance is refining the process of biopsy and diagnosis to obtain more definitive results. Traditional ultrasound does not typically reveal prostate tumors, which makes it hard to know what part of the prostate to biopsy. El Camino Hospital is the first and only South Bay Hospital to offer a new technology to biopsy and diagnose prostate cancer with unprecedented accuracy: Artemis 3D Imaging and Navigation.

Enhancing Traditional MRI with Artemis 3D Imaging and Navigation

Designed specifically for magnetic resonance imaging of the prostate, Artemis combines MRI technology with ultrasound to better visualize prostate cancer. The process begins with an MRI. The radiologist looks for a suspicious dark area, where cells are more densely packed. Measuring blood flow in this area yields more information, as blood flows more quickly through a tumor than through normal tissue. The combination of density, blood flow and other data is graded from 1 to 5. Results above a 2 on the scale calls for a biopsy.

The initial MRI image is fed from a CD into Artemis, which fuses it with real time ultra sound and converts it from a 2D monochromatic ultrasound image to an enhanced 3D color image. The result is exceptionally clear and detailed real-time imaging of prostate abnormalities. This technology advances prostate cancer care in the following ways:

  • Helps determine whether a man can continue with Active Surveillance or whether he needs a biopsy and possible treatment

  • Provides detailed, 3-D real-time imaging the doctor can use as guidance in performing a biopsy

  • Results in more targeted and precise biopsies

  • Allows for the sampling and resampling of cells over time to measure a tumor's growth speed

  • Identifies cancers that may be difficult to see with a traditional biopsy
  • Enables men with non-aggressive, slow growing cancers to avoid or delay surgery

Brachytherapy

Also known as "interstitial radiation", Brachytherapy is implantation of radioactive seeds into the prostate gland. Brachytherapy delivers a prescribed dose of radiation directly to the cancer cells, while decreasing the risk of radiating surrounding tissues and organs. Brachytherapy may be done alone or in combination with external beam radiotherapy and or hormonal therapy. Generally, Brachytherapy is performed as an outpatient procedure. Most patients experience irritative voiding symptoms for several weeks or months after implantation. Complications include bleeding in the urine, urinary retention, and/or radiation induced injury to the bladder and bowel.

A Closer Look at Brachytherapy

Pre-Implant

Before you undergo the seed implant procedure, your urologist may schedule a series of preoperative tests, such as blood tests, chest x-rays, and electrocardiograms.

Image of Brachatherapy SeedImage of brachytherapy seedsYour physician may also request that you undergo a bone scan and Computerized Tomography Scan (CT scan) in order to determine the stage the prostate cancer.

In addition, your urologist will perform a transrectal ultrasound test of the prostate to measure its size and determine the approximate number of seeds that will be needed during the implant.

Implant seeds are about the size of a grain of rice.

Procedure Overview

Brachytherapy is typically done on an outpatient basis. The length of the average procedure is about 60 - 90 minutes.

During the seed implantation, an ultrasound image is taken of your prostate to ensure that the seeds will be placed where they are needed.

You will probably receive general or spinal anesthesia to ensure that you will have no discomfort during the procedure.

Image of Brachytherapy inplantsDuring the seed implantation, an ultrasound image is taken of your prostate to ensure that the seeds will be placed where they are needed.

In real-time your urologist and radiation oncologist can determine with the aid of a sophisticated computer program developed by Varian Corporation, the exact position of each seed for the optimal radiation delivery to the prostate cancer.

Post Implant

After the procedure, you will be taken to the recovery room until the effects of the anesthesia have worn off. Before you leave the hospital, you will receive specific instructions and precautions and, in some cases, your doctor may prescribe antibiotic or other medications.

Your physician may advise that you avoid strenuous types of activity for the first few days after the procedure, but you should be able to resume your normal routine within a matter of days.

Additional Prostate Cancer Treatments

Nerve-sparing Robotic Radical Prostatectomy

A less invasive approach to surgical removal of the prostate. Image of the da Vinci RobotAccessing the internal anatomy through five small incisions, the surgeon performs a very precise, nerve-sparing operation using the da Vinci® Surgical System. This approach may result in more complete eradication of cancer, and retention of bladder control and potency. While the procedure is considered safe and effective, it may not be appropriate for every individual. Ask your doctor about all treatment options, as well as risks and benefits.

Discharge Instructions for Brachytherapy

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Download a PDF of our discharge instructions.

Image of Prostate Precision