Prostate Cancer: Treatment

Treatment options vary depending on the age of the patient, his physical condition, and the aggressiveness of the disease.

Recent advances in the treatment of prostate cancer have raised the ten-year survival rate from 67 percent to more than 90 percent, nearly eliminating local cancers, and extending the lives of men whose prostate cancer has already spread to other areas of the body.

However, it’s important to recognize that no two prostate cancers are alike. Some tumors are more aggressive and need immediate treatment while others fall into the “indolent” or slow-blooming category and are less likely to cause symptoms or to spread to other parts of the body.

Researchers are now trying to determine, with a higher degree of accuracy, what prostate cancers are the most dangerous and should therefore be treated early and aggressively. Every effort is made to avoid over-treatment of indolent cancers because side effects of radiation and surgery, including loss of sexual function and incontinence, can greatly impact a patient’s quality of life.

Experts at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Medical Center treat prostate cancer with the following approaches:

Active Surveillance

For older men with indolent or slow growing prostate cancer, one option is active surveillance otherwise known as “watch and wait.” This approach is appropriate when the cancer does not pose an immediate threat to the patient’s health or if he is dealing with other serious health problems. During active surveillance doctors carefully monitor the patients PSA levels and look for any signs that the tumor is advancing and the cancer is becoming more aggressive. If PSA levels or Gleason Scores rise, the patient may then require treatment.
Some men find it hard to “watch and wait” and to deal with any attendant anxiety. These patients are sometimes reassured by a second biopsy that shows the disease is confined. Others may prefer to initiate treatment, accepting the risks and potential side effects. When treatment is warranted, it may include surgery or radiation, or both.

Surgery

In recent years surgery for prostate cancer has become much more sophisticated and precise, leaving the nerves in this area intact, and thereby preserving sexual function and continence. Columbia Urology surgeons are known for their nerve-sparing techniques and have performed thousands of radical prostatectomies using minimally invasive robotic and traditional open surgical techniques. The team's experience in the full range of minimally invasive procedures is unparalleled in New York, and throughout the United States.

a. Focal therapy The first surgical option for men with early prostate cancer is focal therapy, a noninvasive technique that destroys small tumors while sparing normal issue, essentially leaving the prostate intact. Side effects are few (some incontinence and short-term erectile dysfunction), often temporary and generally less severe that those associated with more aggressive treatments. Often this procedure is performed on an out-patient basis.

A surgeon employs Magnetic Resonance Imaging (MRI) to find the precise location of the tumor, then eliminates it using one of the following methods

• Interstitial Laser Therapy A laser is placed inside the tumor. In this case, heat or thermal energy, is employed to destroy the cancerous tissue.

• High-Intensity Focused Ultrasound (HIFU) Sound waves are used to destroy the tumor the tumor, again by overheating it.

• Focal Cryoablation A solution is injected into the area around the tumor, and then the surgeon freezes the cancerous tissue and destroys it.

Radical Prostatectomy

A radical prostatectomy removes the entire prostate gland, the seminal vesicles, and at times regional lymph nodes to determine if the cancer has spread beyond the prostate. Expertise is required during this operation in order to preserve urinary and sexual function. The surgery may be performed via an open approach where an incision is made in the abdominal wall, or via a minimally invasive robotic approach. The minimally invasive robotic approach uses the da Vinci system that allows for enhanced visualization of the surgical field, greater precision and control of the instruments allowing for greater accuracy and fewer complications of surgery. Patients often have less blood loss, a shorter length of stay in the hospital, and faster recovery times.

More information can be found here.

Radiation Therapy

Radiation therapy can be as effective as surgery when treating early-stage prostate cancer, often providing a lasting cure. It can also improve quality of life for patients whose disease has spread to the bone, causing painful symptoms.

With advanced radiation therapy techniques doctors can better target tumors while reducing the radiation to nearby healthy tissues. Here at HICCC our radiation oncology experts have the ability to provide “state of the art” treatments for prostate disease.

Your radiation oncologist will design the optimal treatment plan with you to ensure you achieve the best outcomes. Treatment delivery can be daily, weekly, every other day, and or single fraction.

If radiation treatment is recommended, a radiation oncologist will work with our radiation oncology team to create a course of treatment. At Columbia University Irving Medical Center treatment modalities available and most commonly used for this cancer are External Beam Radiation Therapy, 3D Conformal Radiotherapy, Image Guided Radiation Therapy (IGRT), Intensity modulated radiation therapy (IMRT), Stereotactic Body Radiotherapy (SBRT) and Brachytherapy.

Hormonal Therapy

The male hormone, testosterone, and related hormones called androgens are known to encourage prostate tumor growth. Hormone treatment may be given by pill or by injection to stop the production of testosterone in the body or to block the effects of testosterone within cancer cells.
Hormonal therapy is often given in combination with radiation therapy with the hopes of increasing cure rates for patients with more advanced or higher risk prostate cancer. Once prostate cancer has spread beyond the prostate to other areas of the body, hormonal therapy becomes a cornerstone of prostate cancer treatment to control the disease.

Chemotherapy

Chemotherapy involves the administration of drugs that stop the spread of cancer. For prostate cancer, these drugs are given intravenously. The two chemotherapeutic agents currently approved for use in patients with metastatic prostate cancer include docetaxel and cabazitaxel. These drugs are generally given in cycles once every three weeks to allow for a period of rest after each infusion so the body can recover.

Immune therapy

The body’s immune system often doesn’t recognize prostate cancer cells as “foreign.” Sipileucel-T is a novel immune therapy that can improve survival for patients with metastatic prostate cancer. This treatment takes a patient’s own white blood cells and exposes them to prostate cancer proteins, “training” them to target prostate cancer. These “trained” white blood cells are then re-infused into the same patient to specifically target cancer cells.

Radium 223

Radium 223 is the newest FDA approved agent for prostate cancer treatment. It specifically targets prostate cancer in the bone. Radium is a radioactive element that when injected into the blood travels to the bone and areas of high bone turnover. There, radioactive particles are emitted to kill cells that are in the immediate surrounding area. In the pivotal ALSYMPCA trial, radium was shown to improve survival in patients with prostate cancer only metastatic to the bones.

Bone targeted therapy

Zoledronic acid and denosumab are two agents that can be given to strengthen bones in men with prostate cancer metastatic to the bone. These bone-targeting agents can relieve bone pain or prevent fractures in patients with advanced prostate cancer that has not responded to hormone therapy. It may also be given to patients who are receiving hormone therapy to prevent osteoporosis or degeneration of the bone.

More information can be found here.