Prostate Cancer Treatment Options-Overview

This section is dedicated to a broad overview of various options available for the
treatment of localized prostate cancer.  Detailed descriptions, pros, and cons of
these options will be found on the links associated with each option.  Treatment
options for prostate cancer include those that do not intend to cure and those that
are intended to cure the cancer.  Watchful waiting and hormonal therapy are non-
curative.  Surgery and radiation are performed with the intention of curing the
cancer.  

Surgical Options
Surgical Options are divided into two categories, open and laparoscopic.  All
surgical methods result in complete removal of the prostate and seminal vesicles.  
In selected patients nerve sparing prostatectomy is performed to preserve
erections and sexual function.  In selected patients pelvic lymph nodes are also
removed.  Open surgery involves making moderate to large skin incisions to
perform the surgery.  Laparoscopic methods are less invasive and involve making
tiny incisions, placing a camera inside the body, and placing pencil thin
instruments to do surgery without cutting the body open.  

Minimally Invasive Surgical Methods for Prostate Cancer:
  • Da-Vinci Robotic Laparoscopic Prostatectomy
  • Standard Laparoscopic Prostatectomy

Open Surgical Methods for Prostate Cancer:
  • Radical Open Retropubic Prostatectomy
  • Radical Open Perineal Prostatectomy


Radiation Therapy
Radiation is divided into two broad categories:  External Radiation and
Brachytherapy.  

External radiation
This is a method in which a machine generates and sends radiation from outside
to penetrate the inside of a patient’s body.  These radiation beams then reach the
prostate in an attempt to destroy the cancer.  There are different types of external
radiation machines that create different type of radiation beams:
  • Helical Tomotherapy
  • Intensity Modulated Radiation Therapy (IMRT)
  • Proton Beam Radiotherapy
  • 3-Dimensional Confromal Beam Radiotherapy

Brachytherapy
This is a method in which radioactive materials are implanted into the patient’s
body.  These implanted radioactive devices, then emit radiation directly from the
inside of the patient’s body (his prostate) in an attempt to destroy the cancer from
the inside.  There are different types of brachytherapy:
  • Real Time Transperineal Ultrasound Guided Seed Implantation
  • Preplanned Transperineal Ultrasound Guided Seed Implantation
  • High Dose Radiation Implant


Watchful Waiting
In some cases, the prostate cancer may be so slow growing as to present a
minimal threat to the patient’s life, especially if it is detected in a patient with
advanced age. In these cases, no treatment is given. The patient is seen by a
physician every few months for DRE, PSA and possible x-rays.

Hormone Therapy
Prostate cancer growth can be temporarily slowed by hormone therapy. Prostate
cancer growth is partially dependent on testosterone, a hormone produced by the
testicles and adrenal gland in men. Hormone therapy can stop the production of
testosterone, or block attachment of testosterone to prostate cancer cells.
Hormone therapy can, therefore, temporarily slow the progression of the cancer.
Prostate cancer usually escapes the need for testosterone over time and starts
growing rapidly despite hormone therapy. This type of prostate cancer is called
“hormone refractory prostate cancer”.
Da-Vinci Robotic Prostatectomy
Laparoscopic Prostatectomy
Open Radical Prostatectomy
External Radiation
Seed Implantation
Hormone Therapy