A New Take on Prostate Cancer
Posted On Oct 15, 2016
In the conclusion of our two-part series on the new realities of prostate cancer, we learn what treatment options can add quantity and quality to our lives, straight from the mouths of experts in the field. (To view Part I of this series, please click here)
BY Karen Asp • RESEARCH by Lisa Kaminsky
A prostate cancer diagnosis happens to other guys, like winning the lottery or having
a tornado hit your house. Yet cancer of the prostate affects more than 233,000 U.S. males on average every year—approximately one in seven annually. Frightening? Yes, but the cure rate is high—especially when caught early. Of the cases diagnosed with the disease in its local and regional stages, nearly 100 percent become disease-free after five years, according to the American Cancer Society. Meanwhile, technology has advanced to the point that men need no longer expect debilitating side effects, such as urinary incontinence and sexual dysfunction.
No “I” in team
When choosing a treatment approach for early-stage prostate cancer, several factors are considered: a Gleason score (which indicates the aggression of your particular cancer), your age, your general health, your individual needs and lifestyle, and the psychological impact of the treatment.
“Some men may have trouble coping with a treatment that leaves part of the cancer in the prostate, while others might be depressed or anxious about dealing with sexual and urinary side effects,” says Herbert Lepor, M.D., of New York University’s Langone Medical Center.
It’s important to work closely with your team of physicians, when weighing pros and cons. Dr. George M. Suarez, a Miami urologist who designed and developed the first high intensity ultrasound HISU system and is the founder and president of the International HIFU Society, encourages his patients to seek out second or third opinions. “A physicians’ specialty training and skills— as well as their own financial interests in a treatment—can sway them to recommend one over another,” he says. Dr. Suarez also warns against selecting a course of action just because someone you know has chosen it. Take the time to research and weigh your options. “Because the majority of prostate cancers tend to be slow growing, you don’t need to take immediate action,” says Brian Sperling, D.O., at Griffin Faculty Physicians in Derby, CT.
Treatments for earlystage prostate cancer fall into four categories— active surveillance, radiation, surgical removal, and ablation. Active surveillance—which involves a wait-and-see approach—is one of the new options being adopted by physicians. “With active surveillance, your doctor will set up a screening schedule based on your cancer profile and monitor you closely,” Dr. Sperling says.
This can be a good choice for older men with health conditions that make surgery an unnecessary risk. It’s also used in the cases of younger men with extremely slow-growing cancer, wary of complications or side effects from other options. Radiation generally falls into two categories. External beam radiation therapy delivers targeted doses of radiation to erection function. Finally, there’s ablation therapy, which involves destroying cancer tissues with extreme temperatures or energy waves. Ablation therapies target either the whole gland (which carries the same risks as RP and radiation the cancer.
This is beneficial if cancer has spread outside the prostate gland. Brachytherapy is the insertion of seed-like radioactive pellets into the prostate to deliver a slow, steady dose of radiation— favored by men who are concerned about potential erectile dysfunction. Another option is prostatectomy, where part or all of the prostate and surrounding tissue are removed through surgery. There are several different types of prostatectomy procedures, including roboticassisted radical prostatectomy (RP), which accounts for approximately 70 percent of all RPs. As the name implies, the technique utilizes robotic assistance to perform surgery through small incisions in the abdomen.
Another surgical procedure is nervesparing RP, in which a physician attempts to spare erectile nerves alongside the prostate in an effort to preserve therapy) or targets the specific parts of the prostate gland where cancer has been found. The latter is called focal laser ablation, with variations that use laser energy; cryotherapy, which freezes tissue with a gas mixture; and high-intensity focused ultrasound (HIFU) that destroys tissue with sound waves and is currently awaiting FDA approval for use in the United States. Dr. Lepor considers focal ablation therapy one of the most exciting advances in prostate cancer treatment, and a real gamechanger. “You avoid side effects like urinary incontinence and erectile dysfunction.”
There’s a lot to consider when selecting an appropriate prostate cancer treatment. “The number one priority is a cure,” Dr. Suarez says. “Priority number two is a cure without any collateral damage.” Lucky for us all, options abound, and now look better than ever.