Prostate Cancer

Prostate cancer can be treated by a number of different radiation modalities. All of our centers offer IMRT, a highly technical way of delivering high doses to the prostate and minimizing dose to the surrounding critical structures. Many of our centers offer Image Guidance so that the exact position of the prostate can be verified each day before delivery of each fraction. Some patients are candidates for brachytherapy, a technique where radioactive sources are inserted into the prostate to deliver radiation from the inside out, thereby minimizing dose to the surrounding structures. You physician can help you decide which treatment option is most appropriate for you.

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Cancer of the prostate is the most common cancer in men accounting for over 200,000 cases in 2007. Most men are diagnosed after having an elevation in Prostate Specific Antigen (PSA) noted on a routine blood test and occasionally a nodule is felt on digital rectal examination. This leads to referral to an Urologist and eventually biopsies of the prostate. After the diagnosis of prostate cancer is established the prognosis is determined by several features:

It is generally felt that the higher the PSA level, the higher the risk that the cancer has spread outside of the prostate gland. A PSA less than 10 is felt to have a low risk of spread. A PSA of 10-20 is intermediate and a PSA greater than 20 is high risk.

After establishing a diagnosis of cancer the pathologist will further classify the cancer by how aggressive it looks under the miscroscope. He will give a score to the two most predominant patterns and that score ranges from 1 to 5. Then the two scores are summed to come up with the Gleason score. The higher the Gleason score the higher the risk of cancer having spread outside the prostate capsule or to other parts of the body. Typically a score of 5-7 is common and considered low to intermediate risk. A score of 8-10 is high risk.

The staging of prostate cancer cannot be considered by itself to determine prognosis because it is only based on how the cancer feels on digital rectal examination. Most cancers will not be detectable by digital exam at all.

It is important to know all of the features above in order to determine an individual patient’s prognosis. Knowing the above variables, we can determine the likelihood of the cancer being confined to the prostate gland and the risk of spread to lymph nodes or other parts of the body.

The treatment of prostate cancer should be tailored to the stage and prognostic information for that particular patient. Treatment can range from conservative options such as watchful waiting to more aggressive treatment options like surgical removal of the prostate, external beam radiation therapy or prostate seed implant. Each treatment may not be appropriate for every patient’s disease. Only by talking with your doctors can you determine which is right for you. Many patients with early stage cancer are eligible for all of the options and only by hearing the potential side effects and risks can you make an informed decision. Urologists perform the surgical treatment of prostate cancer and will be able to answer your questions regarding this. Our doctors are skilled in performing both external radiation therapy and prostate seed implants.

This is a term used to refer to a series of radiation treatments given daily by a linear accelerator and are referred to as “external” because the treatments are given from outside of the body and aimed at the prostate gland and surrounding tissues. Generally patients come in daily Monday through Friday for a low dose of radiation and typically do this for 8 or 9 weeks. There are several ways of giving external radiation therapy but the preferred way at our centers is either 3D conformal radiation therapy (CRT) or intensity modulated radiation therapy (IMRT). Both are ways of treating the prostate and surrounding tissues while avoiding the majority of the rectum, bladder and pelvic and hip bones to minimize side effects.

This refers to a surgical procedure done in the operating room to implant radioactive seeds directly into the prostate gland. The procedure takes approximately 2-3 hours and is done under general anesthesia. Approximately 80-150 seeds are placed permanently into the prostate gland. They contain a radioisotope which gradually decays over time. It is a convenient option for treatment of early stage prostate cancer with a quick recovery and very little time off of work.