Located just below the bladder and in front of the rectum, the prostate is a gland in the male reproductive system that produces fluid for semen. The prostate is about the size of a walnut and surrounds the urethra, the tube that carries urine from the bladder through the tip of the penis. As men get older, the prostate enlarges and may block the flow of urine. It may also develop tumors that can be cancerous or benign. Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. If left untreated, the cancer can grow and spread to other parts of the body, resulting in aches and pains in the bones, pelvis, hips, ribs and back.
The American Cancer Society estimates that 180,000 to 200,000 men are diagnosed with prostate cancer in the United States annually. Prostate cancer is the second-leading cause of cancer death in men in the United States, with approximately 40,000 men dying of it each year.
St. Peter's Cancer Care Center includes a specialized Prostate Cancer Center, designed to provide men with the most extensive scope of services to help with the diagnosis and treatment of prostate cancer. Our multidisciplinary team of specialists includes: urologists; surgical, radiation and medical oncologists; allied health professionals; a nutritionist; and, clinical social workers.
There are a variety of treatments for prostate cancer, depending on the patient's age and condition, and whether the cancer has spread to other parts of the body. Treatment options include watchful waiting, hormone therapy, radiation therapy and surgery.
Patients will want to discuss the options of radical prostatectomy, robotic prostatectomy, shaped beam system, IMRT external beam radiation therapy, prostate brachytherapy (seed implant) and surveillance alone.
Radical prostatectomy: one of the most common treatments for prostate cancer involves the surgical removal of the prostate gland and seminal vesicles. The surgery is known as radical prostatectomy. Traditional radical prostatectomies are performed through large, open surgical incisions, which can result in lengthy and uncomfortable patient recovery, substantial blood loss and significant risk of impotence and incontinence. In recent years, some surgeons have begun using a less invasive technique called laparoscopic radical prostatectomy.
Robotic prostatectomy: one of the latest advances in prostate surgery is robotic prostatectomy. With the da Vinci® Surgical System, the surgery is so precise that instruments recheck their positions by computer 1,500 times per second. Seated at a console near the patient, the surgeon uses a high-powered camera with a headrest to view a color, high-resolution, 3-D image of the surgical field, magnified 10 times. Using glove-like "endo-wrists," the surgeon manipulates the instruments by flexing his/her thumb, forefinger or wrist in a joystick-like control.
For many patients, a major concern about surgery for prostate cancer is the possibility of life-changing complications. But robotic surgery helps lower the risk of complications. Because there is little bleeding, the surgeon has a crystal clear view inside the patient. This is not always the case in traditional open surgery.
Typical benefits of robotic surgery:
- faster healing;
- smaller incisions with less scarring;
- much less pain after the procedure;
- faster recovery;
- less blood loss and need for transfusions; and,
- a shorter hospital stay.
Shaped beam radiosurgery: shaped beam radiosurgery allows physicians to reach those difficult-to-reach tumors and lesions with much more accurate and precise doses of high-energy radiation. Using computerized and highly sophisticated software, a team of specialists develops a customized treatment plan. The treatment plan may involve multiple treatments during the course of several treatment days. Shaped beam surgery continuously shapes the treatment beams to match the size and shape of the tumor from all angles. This ensures that the tumor receives the fully prescribed dose of radiation. All the while, the surrounding normal tissue is spared, protecting critical organs surrounding the prostate.
Benefits of shaped beam surgery include:
- tumors or lesions receive an even and exact dosage of the prescribed radiation;
- extremely precise radiation minimizes damage to normal tissue;
- no scarring or disfigurement and little risk of infection;
- noninvasive and virtually painless; and,
- performed on an outpatient basis.
Prostate brachytherapy: prostate brachytherapy (PSI), also called "prostate radioactive seed implant," is used to treat patients with prostate cancer. This treatment eliminates the need for traditional, invasive surgery. It does not involve cutting or significant bleeding, and most patients go home the day of the procedure. It is sometimes used in combination with other treatments.
During PSI, radioactive seeds (about the size of a grain of rice) are implanted directly into the diseased prostate. The seeds release gradual doses of concentrated radiation for about a year, destroying cancer cells. Special computer programs calculate the exact dose of radiation needed. The cancer cells are carefully targeted with the help of advanced medical imaging equipment so that very little healthy tissue is affected. The seeds never have to be removed.
PSI is performed by a team of specialists including a urologist, radiation oncologist, medical physicist and registered nurse.