Treatment of Prostate Cancer

DaVinci Technique Offers Better Surgery Outcomes for Patients

The treatment for prostate cancer depends on a variety of factors, including the patient's age and how advanced the cancer is. Many men who are diagnosed with prostate cancer will have radical prostatectomy, surgery to remove the prostate, a walnut-sized gland that is part of the male reproductive system. The prostate surrounds the urethra, the tube that empties urine from the bladder, and produces the fluid that is part of semen. 

Conventional methods for prostate surgery involved an eight- to ten-inch incision in the abdomen. It often results in substantial blood loss and a lengthy, uncomfortable recovery. Because the prostate is located near the bladder and the nerves that control erections, men who have their prostates removed are at risk for incontinence and impotence -- they may be unable to control their urine flow or to achieve erections.

Lakeland Health, following its commitment to offer the best possible care to area residents, now offers surgery with the da Vinci Surgical System, the most advanced technology available for minimally invasive surgery.

Currently, the da Vinci system is used primarily for radical prostatectomy, or removal of the prostate. Using the da Vinci system, surgeons can see inside the body more clearly and perform complex surgeries through tiny incisions. Patients and their families can enjoy peace of mind in electing to have surgery using this state-of-the-art technology in their own community.

Some men who have had the da Vinci procedure have noted they needed no pain drugs after surgery. Many men have found they regained control of their bladders and achieved erections within weeks, rather than months, of surgery. In addition, recent studies suggest that the robotic-assisted surgery provides better cancer control when the cancer is confined to the prostate.

While most radical prostatectomies can be performed with the da Vinci system, some men may not be candidates because of other health problems.

During the radical prostatectomy, five tiny cuts are made in the abdomen. The EndoWrists are attached to the robotic arms and placed into four of the cuts in the abdomen. The fifth cut is used for the vision system, which allows the surgeon to view the operative site in three dimensions.  Using this vision system, the surgeon can see the prostate from any viewpoint and avoid important structures, such as the nerves that control potency and bladder control.

The surgeon, working at a console in the operating room, views the operating field and uses controls to operate the robotic arms and EndoWrists. The da Vinci system transfers the surgeon's exact hand and finger movements to precise microsurgical movements in the operative field.

Radiation Therapy Options for Treating Prostate Cancer

After a diagnosis of prostate cancer has been established with a biopsy, the patient should discuss the treatment options with a radiation oncologist and an urologist. Radiation therapy treatment options to cure prostate cancer include:

  • External beam radiotherapy
  • Prostate brachytherapy

External Beam Radiation Therapy

External beam radiation therapy involves a series of daily outpatient treatments to accurately deliver radiation to the prostate.

There are two principal methods for delivering external beam radiation.

  • 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the prostate. Tailoring each of the radiation beams to accurately focus on the patient's tumor allows coverage of the prostate cancer while at the same time keeping radiation away from nearby organs such as the bladder or rectum.
  • Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT improves on 3D-CRT by modifying the intensity of the radiation within each of the radiation beams. This technique allows more precise adjustment of radiation doses to the tissues within the target area, potentially allowing an increased radiation dose to the prostate and reduced doses to nearby normal tissues. Higher doses to the prostate translate into a greater chance for cure, while lower doses to surrounding organs mean fewer side effects.

Both types of external beam radiation therapy are acceptable treatment; IMRT offers advantages for some but not all prostate cancer patients. With either type of therapy, painless radiation treatments are delivered in a series of daily sessions, each under half-hour in duration, Monday through Friday for seven to ten weeks overall.

Potential side effects, including fatigue, increased frequency or discomfort of urination, and loose stools, typically resolve within a few weeks after completing treatments. Impotence is also a potential side effect of any treatment for prostate cancer. However, many patients who receive radiation therapy for prostate cancer are able to maintain sexual function.

Prostate Brachytherapy

Prostate brachytherapy, better known as a seed implant, is often done in the operating room.

There are two methods of delivering internal radiation for prostate cancer:

  • Permanent seed implants
  • High-dose rate temporary seed implants

These treatments are designed to deliver a very high dose of radiation to the tumor by inserting radioactive seeds directly into the prostate gland under ultrasound guidance while the patient is under anesthesia. Isotopes of iodine or palladium are most commonly used. The seeds are approximately four millimeters long and less than a millimeter in diameter. In certain situations, both prostate brachytherapy and external radiation may be recommended to combat the tumor.

The side effects from seed implants are similar to those experienced with external beam radiotherapy. Patients usually experience urinary frequency and discomfort in urination. These effects may be lessened with medication and usually dissipate over the course of three to six months.

Other treatment options include:

  • Proton Beam Therapy: In a few parts of the country, proton beam therapy is being used to treat prostate cancer. Proton therapy is administered much the same way as external beam therapy, but it uses protons rather than x-rays to irradiate cancer cells.
  • Hormone Therapy: Certain patients may benefit from hormone therapy in addition to radiation. In some patients, hormone therapy works with radiation therapy to improve cure rates.
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