Prostate Cancer

According to the American Cancer Society, 1 in 7 men will be diagnosed with prostate cancer during his lifetime. At Affiliated Urologists, we treat patients affected by prostate cancer with the utmost care. Learn more about the following treatment options.

Da Vinci Radical Prostatectomy 

The radical prostatectomy procedure is performed to remove some or all of the prostate and the attached seminal vesicles affected by cancer. Our physicians perform this procedure if cancer is in the early stages and localized in the prostate. However, if the cancer has spread to the lymph nodes, they may be removed during the procedure as well. Many of the Affiliated Urologists physicians specialize in minimally invasive surgery and can perform this procedure using minimally invasive laparoscopic or robotic techniques. This means that the patient can experience a faster recovery time, minimal scarring, and less blood loss compared to open prostatectomy procedures. However, minimally invasive surgery is not for everyone and an open radical prostatectomy may be necessary in some cases. Depending on the patient, different open surgical approaches may be taken including retropubic, with an incision in the low abdomen, perineal, with an incision between the anus and the scrotum, and various others. 

The night before the procedure, the patient may be asked to fast and avoid non-clear liquids. The physician may also require patients to avoid certain medications and supplements and stop smoking cigarettes about a week before the radical prostatectomy. Once the patient has changed into a gown and emptied his bladder, the patient will be prepped and sanitized. General anesthesia is then administered, and the surgeon will begin by making a small incision, most commonly on the abdomen. The prostate gland, seminal vesicles, and surrounding tissues are then removed using nerve-sparing techniques. The surgeon can decide whether or not the nearby lymph nodes need to be surgically removed and tested for cancer. The urethra is reattached to the bladder neck in order to restore the flow of urine, but a catheter may need to be worn for a few weeks after the procedure. Once the prostate cancer has been removed, the incision is sutured and bandaged.

Prior to the surgery, the Affiliated Urologists physicians may discuss the risks of radical prostatectomy surgery. The prostate gland is positioned near the neck of the bladder, so it is possible to have problems with urinary incontinence after the procedure. Also surrounding the prostate gland is a set of nerves that are responsible for helping get and sustain an erection. Problems with erectile functioning are a risk when treating prostate cancer with this method, but the expert surgeons at Affiliated Urologists utilize a nerve-sparing technique to minimize the risk of this occurring.

After the patient wakes up from surgery, he may need to stay connected to an IV in order to receive medication and fluids. The patient may also have a catheter to wear at home for the few weeks following surgery. Eating and walking may be resumed as soon as comfortable. Because Affiliated Urologists uses minimally invasive techniques, patients do not need to stay at the hospital as long those who have undergone traditional open prostatectomy surgery, but they will still need to spend some time recovering at home. Patients should not drive or return to work until the physician agrees it is suitable to do so. Patients should not soak their bandaged wound for extended periods of time and always keep the area clean and dirt-free.

Patients may be asked to return for follow-up visits with their physician in order to have bandages removed, check on how the wound has healed, and answer any questions. The physician may suggest biopsies or regular checkups of the prostate to ensure that the cancer has not returned or spread to anywhere else in the body. Patients should always look for signs of infection including redness, fever, a sudden increase in pain, or trouble urinating without the catheter in place. If patients experience one or more of these symptoms, they should call Affiliated Urologists as soon as possible.

Pelvic Lymphadenectomy

The pelvic lymphadenectomy procedure, also known as pelvic lymph node dissection, is performed to remove the lymph nodes in order to look for cancerous cells within them. This is important because if cancer cells get to the lymph nodes, they can travel to other parts of the body and metastasize. 

There are a number of urologic cancers that can spread to the pelvic lymph nodes including bladder, prostate, and penile cancers. If the cancer is found to have spread, the physician and the patient can begin to discuss a more aggressive cancer treatment plan. It is possible for the surgeon to perform this procedure while performing a radical prostatectomy, but it can also be performed as a separate procedure.

An Affiliated Urologists physician will meet with the patient prior to the surgery to discuss the procedure and answer any questions the patient may have. During this meeting, the patient may be instructed to avoid eating any food and non-clear liquids the night before surgery. In addition, patients should notify the physician of any medications or herbal supplements they are taking. The physician may want the patient to stop taking the medication before the surgery, particularly ones that interfere with the blood’s ability to clot. On the day of the procedure, the patient will be sterilized and general anesthesia will be administered. The surgeon begins by making a small incision. 

Affiliated Urologists believes in using a minimally invasive approach, so rather than making one large incision, they can perform this procedure using multiple small incisions. The lymph nodes are then carefully separated from surrounding tissues and removed using nerve-sparing practices. Once the procedure is complete, the surgeon will apply stitches and bandages and the patient can be taken to the recovery room. Overall, it is a relatively short procedure and because of the minimally invasive techniques used during the pelvic lymphadenectomy, the patient’s hospital stay is shorter as well. 

Patients will likely remain at the hospital for 3-4 days. Here, the hospital team can monitor for signs of infection, although patients may be asked to take antibiotics to lower their risk. Patients may also need to wear a Jackson-Pratt drain to clear away excess fluids for a few weeks. Patients should try to avoid touching the wound, dressings, and drain as much as possible and only do so with clean hands. Patients should not drive and should arrange for a caregiver to come take them home. 

Once home, patients should rest and avoid strenuous activities. If any discomfort is felt following the procedure, pain medication may be taken as directed. The patient may need to return to Affiliated Urologists for a follow up visit to have any staples or stitches removed and determine the best course of action if the cancer was found to have metastasized to other parts of the body. If the patient suspects that the incision site has become infected or notices any signs of nerve damage or excessive bleeding prior to this meeting, our physicians urge patients to call Affiliated Urologists immediately. 

Radiation Therapy 

Radiation therapy is typically used to treat prostate cancer during early stages when the cancer is still in the prostate gland. However, it can also be an effective treatment for recurrent prostate cancer or cancer that has spread to other areas of the body. There are several different types of radiation therapy that may be used, and while all use radiation to treat cancer, the difference lies in how the radiation beam is directed to the prostate. The two most common forms are known as external beam radiation and internal radiation (brachytherapy). Both options utilize high doses of radiation in order to prevent cancer cells from dividing and spreading by killing off the cells. This method has proven to be beneficial to patients because unlike other forms of treatment, damage to healthy cells is minimal.

Patients undergoing external beam radiation therapy (EBRT) will undergo this procedure multiple times per week for up to nine weeks. The cancer experts at Affiliated Urologists may recommend treatment up to five days per week for more aggressive treatment. EBRT begins with a stage called simulation, where the patient is positioned in the optimal position for radiation therapy. Additional tools may be needed to ensure that the patient stays in the same position each day. The procedure itself does not cause pain and only lasts for a few minutes.

During brachytherapy, the patient is put under anesthesia and a radiation source known as a seed is surgically implanted into the prostate. Numerous seeds can be placed through an applicator depending on the stage of cancer and the size of the prostate. Because the small seeds are placed near the tumor, there is less risk of damage to healthy cells in the prostate. The seeds are small and do not usually cause discomfort to the patient. In some cases, patients may need both brachytherapy and EBRT if the patient is at risk of cancer spreading outside the prostate.

After undergoing radiation therapy, patients will be asked to come in for follow-up appointments. The physician will then perform a number of tests to determine whether the cancer has been successfully eliminated.

Patients may develop side effects following radiation therapy treatment including fatigue, fluid retention, or impotence, as well as short-term skin irritation such as redness, sensitivity, or peeling. In some cases, patients may develop conditions known as radiation proctitis or cystitis, referring to issues with bowel movements or urination as a result of radiation. These conditions can temporarily cause diarrhea, bowel incontinence, or pain while urinating. Some of these side effects may not occur for several years after treatment, so it is important to come in for regular follow-up appointments. Our physicians may be able to recommend skin care products to ease irritation and provide treatment for any other side effects.   

Hormone (Androgen-Deprivation) Therapy

Hormone therapy, also referred to as androgen deprivation therapy (ADP), is used in the treatment of prostate cancer. Testosterone and other androgens are hormones produced primarily in the testicles, but also the adrenal glands. Lowering the levels of these male hormones can slow the progression of prostate cancer and potentially reduce the size of a tumor because, without these androgens, the cancer cannot grow. A variety of prostate cancer patients can benefit from this procedure. Sometimes, it can be used initially to shrink the tumor and make it more manageable to treat with other means. In other cases, it can be used to help patients whose cancer has metastasized or in cases of recurrent prostate cancer. Hormone therapy is typically used in conjunction with another form of treatment for the most effective results. 

There are a few different hormone therapy treatment options depending on the patient and the stage of cancer. One option is a procedure known as an orchiectomy. This surgical procedure removes the testicles and can reduce the amount of testosterone present in the blood by about 90%. If the Affiliated Urologists prostate cancer expert decides an orchiectomy is the best option, patients will be asked to fast, stop smoking, and avoid certain medication prior to the procedure. Once the patient comes in on the day of surgery and is given general anesthetic, the area is sterilized and the penis is positioned against the abdomen. The surgeon then carefully removes one or both testicles and sutures the incision closed.

Alternatively, patients can use drugs to reduce hormone levels in the body. The classes of drugs include luteinizing hormone-releasing hormone (LHRH) agonists or antagonists, and anti-androgens. LHRH antagonists lower the amount of testosterone made in the testicles, but as a result, the testicles may shrink. These drugs may be injected every few of months, but some physicians may suggest more frequent dosages. Initially, LHRH agonists can cause testosterone to temporarily flare up and cause pain. LHRH antagonists lower testosterone at a slower rate preventing flares. It is also administered as a monthly injection. Anti-androgens are taken in pill form and may be used to assist LHRH agonist or orchiectomy in the suppression of testosterone. This method may not be as effective when used alone, but it does not produce as many sexual side effects as the other hormone suppressant drugs.

Hormone therapy methods may cause a number of side-effects including loss of sex drive, shrinkage or loss of the testicles, impotence, osteoporosis, fatigue, hot flashes, nausea, and more. Prior to the procedure, an Affiliated Urologists physician can go over these side effects with the patient and decide which method of hormone therapy to pursue. Patients can return for follow-up visits during or after their course of prostate cancer treatment to receive additional treatments to help manage these side effects. After completing the hormone therapy treatment, the patient will continue to have their prostate cancer monitored. Because hormone therapy is not typically used alone, the physician can determine which treatment would be most beneficial to the patient once their androgen levels have slowed tumor growth.

Monoclonal Antibody Therapy

Monoclonal antibody therapy is a relatively new immunotherapy treatment made available to prostate cancer patients. Monoclonal antibodies are drugs that can identify cancer cells and help the immune system get rid of them. Unlike germs and viruses, cancer cells are already present in the body. They start out as normal cells and mutate into cancer cells, so the body may have a hard time identifying them as invaders. Monoclonal antibodies attach to certain proteins within the cancer cells and begin to fight them while also making it easier for the immune system to identify. They also help to shrink tumors in the prostate by cutting off its blood supply. In some cases, an oncologist may combine chemotherapy or radiation to the monoclonal antibodies in order to deliver the treatment directly to the cancer cells and minimize hard to the healthy cells. 

Before deciding to undergo monoclonal antibody therapy treatment, an Affiliated Urologists cancer expert must determine whether the patient is a good candidate for the procedure. It is typically used on patients with advanced prostate cancer, but some patients in the early stages of prostate cancer may benefit as well. During the procedure, patients will have their skin cleansed and given the drug intravenously. A team of providers will be monitoring the patient for any signs of allergic reaction. Reactions are rare but as a precaution, an antihistamine may be administered before the treatment begins. There are a number of FDA-approved monoclonal antibody drugs available, and depending on the drug and stage of cancer, the physician can determine how often the patient should have this procedure repeated. If necessary, patients may undergo the monoclonal antibody therapy procedure at the same time as another form of treatment for the best results.

Following monoclonal antibody therapy, patients may experience some side effects including nausea, vomiting, weakness, fever, difficulty regulating blood pressure, blood clots, skin irritation, and more. Monoclonal antibodies that are used alone generally produce fewer side effects than those combined with chemotherapy and radiation treatment. A physician will go over these possible side effects depending on the method of monoclonal antibody treatment and work with patients to ease symptoms if side effects interfere with the patient’s quality of life. Patients may be asked to return for follow-up appointments so the cancer can be monitored to ensure that the drug is working and the cancer cells are dying off. 

Cryosurgery

Cryosurgery is a treatment for patients with prostate cancer in its early stages. Good candidates for this procedure include patients with localized prostate cancer or cancer that has barely spread beyond the prostate. It can also be beneficial to those who underwent treatment and had their cancer return. Despite the name, it is not actually a surgical procedure and can sometimes be dubbed as “cryotherapy.” The goal of this procedure is to destroy cancer cells through a controlled freezing in the prostate. Because this process kills all cells and tissues in and around the prostate, blood vessels may also be destroyed cutting off the blood supply to any remaining cancer cells in the area, effectively killing them off.

Because cryosurgery may use epidural or general anesthesia, patients may be asked to stop smoking and taking certain medications a week before the procedure and to avoid all foods the night before the procedure in order to reduce the risk of complication during the procedure. After the patient is under anesthesia, a physician uses an ultrasound device to guide needles into the perineum (the area between the anus and scrotum). Once the needles are positioned correctly in the prostate, cold gasses are pushed down the needle in order to freeze it. A catheter is positioned so a warm saline solution can flow to the urethra so it does not freeze or become damaged in the process. The experts at Affiliated Urologists take extra precautions to monitor the surrounding areas to ensure the freezing process does not affect them. This helps to reduce side effects that may accompany this procedure like conditions of the rectum. The physician may allow the prostate to partially thaw and perform another freezing cycle.

Patients may be monitored for a brief period as the effects of the anesthesia wears off. Because cryosurgery is an outpatient procedure, patients may be permitted to have a caregiver drive them home the same day. Patients will leave the hospital with a catheter in place. Patients may need to return to have the catheter removed in about a week or two, or as soon as they can comfortable urinate on their own again. Most patients do not experience significant levels of pain while recovering from the procedure, but pain medication may be taken if the patient is uncomfortable. Patients may experience side effects including erectile dysfunction, blood in the urine, infection, and more, although these side effects are very rare. An Affiliated Urologists physician may be able to help patients manage these side effects following the procedure. Physicians will continue to monitor PSA levels every few months and may perform biopsies to monitor levels of cancer cells. If PSA levels are consistently stable, patients may only need to come back on an annual basis as needed. If necessary, cryosurgery may be repeated, unless a physician recommends a different prostate cancer treatment depending on the stage of the cancer.  

High-intensity Focused Ultrasound (HIFU)

High-Intensity Focused Ultrasound is a treatment for patients who have localized prostate cancer. It is best suited for patients with one tumor or tumors placed closely together and is not an effective treatment for widespread prostate cancer. The goal of this procedure is to kill off cancer cells using high-intensity sound waves that produce heat when focused directly onto the prostate gland. It is a relatively new procedure made available to prostate cancer patients and is still being researched, but overall, it can be a very safe and efficient procedure.

Patients may be asked to empty their bowels the day before the procedure and arrange for a caregiver to drive them home afterward. Patients may also be asked to avoid eating food the night before the procedure to avoid complications during the procedure. After the patient has asked any last minute questions and changed into a gown on the day of the ultrasound, the minimally invasive outpatient procedure begins with an anesthesiologist administering either general anesthesia or an epidural injection to maximize comfort to the patient. A small, sterilized probe is then lubricated and inserted into the rectum. This probe allows physicians to see the prostate and surrounding areas so they can be divided into sections based on where the cancer cells are located. High-intensity focused ultrasounds can only focus on a small area at a time in order to be most effective. The probe emits high-intensity ultrasound waves through the tissues and into the focused area of the prostate. As the prostate absorbs the beam, it heats up and starts damaging the tumor. Extra precautions are taken by the ultrasound team to ensure that the rectum is not heated up as well. When one area is treated, the beam is moved slightly onto the next target area. Depending on the size of the tumor, this process can take up to an hour and a half. Once the procedure is over, the patient is taken to a recovery room until the anesthesia begins to wear off.

Patients may be given pain medication to help ease any soreness as well as an antibiotic medication to reduce the risk of infection. In addition, patients may have to wear a catheter after their ultrasound. Patients will be briefed on how to care for it, as it may need to stay in place for a few days after returning home. Unlike other forms of cancer treatment, high-intensity focused ultrasounds do not produce as many side effects. Although rare, patients should contact Affiliated Urologists if they get a high temperature or experience a sharp increase in pain. It is also possible for patients to experience incontinence or problems keeping and maintaining an erection as a result of the ultrasound. Patients may be asked to return for follow-up visits where the physician can determine the success of the procedure and the best course of cancer treatment from there. 

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