As technology advances, so does the number of treatment options for prostate cancer. Options depend on the stage of the disease, your age, your doctor's recommendations and personal decision. When appropriate, your doctor may also suggest enrolling in national clinical trials. The trials compare two or more different treatments.

Treatment options available through HealthEast Prostate Care include:

Watchful waiting/observation

This option simply monitors the tumor. This is sometimes the choice for men with a low PSA score and/or a small tumor. Rather than treat the cancer, your doctor regularly monitors your PSA value to assess whether it is increasing and at what rate.

Ideally, patients and their doctors who choose this option identify a point at which therapy would be instituted (for example, a PSA value of a certain number or the presence of bone pain).

Surgery

The most common surgery, radical retro pubic prostatectomy or RRP, is the removal of the entire prostate gland and the seminal vesicles. This is often considered the most effective way to eliminate cancer that is confined to the prostate.

What can I expect to happen at the hospital?

Typically, you are admitted on the day of your surgery and remain in the hospital for two or three nights (including the night of your surgery).

An epidural catheter (a small catheter placed through the lower back into the space around the spinal cord) is often used to control pain after surgery. Medication can be given through the catheter to numb the nerves and reduce pain. Another way to control pain after surgery is with a patient-controlled analgesia (PCA) pump. This is an intravenous (IV) form of pain medication that you control with a small button.

You will be discharged with a Foley catheter to drain urine from your bladder. The catheter will allow the area where the bladder has been reattached to the urethra to heal.

Rehabilitation after prostatectomy

After a prostatectomy, HealthEast Optimum Rehabilitation in Maplewood offers pelvic floor rehabilitation, including biofeedback, electrical stimulation and exercises. For more information, call 651-232-7820.

Minimally invasive surgery

We offer the da Vinci Surgical System as a less invasive alternative to traditional surgery. The da Vinci is powered by robot-assisted technology and is used to remove the prostate gland through five or six small incisions (each about one inch in length). Patient benefits often include shorter hospital stays, less pain, less blood loss, less risk of infection, less scarring and faster recovery and return to normal activities.

Brachytherapy (interstitial seed therapy)

Also known as interstitial irradiation or interstitial seed therapy, this treatment involves the placement of radioactive "seeds" directly into the prostate gland. The seeds deliver high doses of radiation to targeted areas of the prostate. Brachytherapy is a less invasive approach than surgery.

What is the success rate of brachytherapy?

The results of prostate brachytherapy are comparable to those of radical prostatectomy for five to seven years after treatment. The long-term data (longer than 10 years after treatment) are limited. Studies demonstrate success rates of 74% at seven years, with success being defined by either a PSA of less than 0.5 ng/mL or the absence of three consecutive rises in PSA in patients who received brachytherapy and external beam radiation therapy (EBRT).

What happens the day of the procedure?

The brachytherapy procedure is preformed under anesthesia (either spinal or general). A Foley catheter is placed into the bladder, and a small amount of contrast material (x-ray dye) is placed into the balloon of the catheter so that the balloon can be visualized under fluoroscopy, which is used for examining deep structures with x-rays.

Using a plan prepared from prior CT scans, the doctor uses a needle to place the seeds in the prostate.

When the procedure is complete, fluoroscopy is used again to make sure that no areas of the prostate are missing seeds. The catheter is then removed, and a cystoscopy (a telescope-like device to look into the bladder) is used to make sure no seeds are in the bladder or urethra. If seeds are found in the bladder or urethra, they are removed. You will go home after a short recovery time in the hospital.

External beam radiation therapy (EBRT)

External beam radiation therapy (EBRT) is the use of radiation therapy to kill or inactivate cancer cells. Radiation is given in separate, smaller doses known as fractionation.

Cancer cells are most sensitive to radiation at different phases in their growth. By giving radiation on a daily basis, the goals are to catch cancer cells in different phases of growth and to prevent the cells from recovering from prior doses of radiation. EBRT has a seven year survival rate of 79%.

This type of radiation therapy can be used to treat early stage or late stage prostate cancer. It can also help alleviate bone pain in advanced prostate cancers.

What are the side effects of EBRT?

The severity of side effects varies with the dose of radiation, type of treatment, site of treatment and your tolerance. Common side effects include changes in bowel habits, bowel bleeding, skin irritation, edema, fatigue and urinary problems.

What does the treatment entail?

EBRT treatments are often given five days a week (Monday through Friday) for six to seven weeks, depending on the total dose selected by your doctor. In some cases, the radiation oncologist may choose to add hormone therapy to your regimen.

Cryoablative surgery (cryosurgery or cryotherapy)

Cryosurgery is used to freeze and destroy the tumor in the prostate. It is generally used for early stage tumors, which have not spread outside the prostate. The procedure is performed under anesthesia. Ultrasound is used during the procedure to visualize the prostate and to monitor the position of the probes that are used for freezing the tumor. The freezing process kills both hormone-sensitive and hormone-insensitive cancer cells.

What is the success rate of cryotherapy?

For patients who don't respond to EBRT treatment and go on to have cryosurgery:

• Approximately 40% have an undetectable PSA level after the procedure
• 78% have negative biopsy results after the procedure

What are the common side effects of cryotherapy?

Common side effects include perineal pain, urinary retention, blood in the urine and erectile dysfunction.

Hormonal deprivation

Hormonal deprivation can be accomplished with an orchiectomy (removal of the testes) or with luteinizing hormone-releasing hormone (LHRH) agonists like Lupron or Zoladex. Both ways reduce testosterone levels, which slows the activity of the prostate cancer.

Chemotherapy

Chemotherapy uses anti-cancer medications to control the growth of prostate cancer. Several chemotherapy drugs are available for use in advanced prostate cancer.

Side effects of chemotherapy vary depending on the drug and may be reduced by using smaller doses on a weekly basis.