Prostate Cancer Treatment
There are different types of treatment for patients with prostate cancer, which depend on the stage of the cancer and the person’s overall health.
At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer. This includes standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important. As part of a research medical center, physicians at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principal investigators in these trials, which cover medical, surgical and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.
The major treatments for prostate cancer are centered on surgery and radiation to treat local tumors and chemotherapy to treat the whole body, especially cells that have spread. Other approaches are being tested as part of clinical trials, some of which are becoming standard of care.
Standard Treatments for Prostate Cancer
This may be a good option for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.
Surgery and Other Procedures for Prostate Cancer:
Male lumpectomy: This novel approach to treating prostate cancer destroys the tumor in its original place. By visualizing the tumor with precision on MRI, surgeons can do an ablation to destroy the tissue with a laser or freeze it with a special needle. It can be done outpatient with no risk of incontinence or sexual dysfunction.
Radical prostatectomy: During this prostate surgery, the whole prostate gland is removed, along with surrounding tissue, seminal vesicles and sometimes nearby lymph nodes. This would be done when the cancer is confined to the prostate.
Ultrasound ablation of the prostate: High-intensity frequency ultrasound (HIFU) can also destroy the tumor without harming the prostate.
Pelvic lymph adenectomy: Removal of the pelvic lymph nodes is done so a pathologist can check them for cancer.
Transurethral Resection of the Prostate (TURP): This prostate surgery is done through the urethra with a tube called a resectascope to remove prostate tissue. Usually done for BPH, it can also be done to relieve symptoms caused by a tumor before other treatment is given.
Radiation to the prostate is given with curative intent. Radiation oncology has active trials for treating patients with aggressive cancer using combinations of radiation with hormone therapy. Patients with lower-risk disease can be safely treated with radiation alone, often with shorter courses to minimize the number of trips to the treatment center.
IMRT: Siteman radiation oncologists were among the first in the U.S. to use Intensity-Modulated Radiation Therapy (IMRT) to enhance the delivery of high doses of radiation for prostate cancer. Using daily Image-Guided Radiation Therapy (IGRT) along with IMRT, they can precisely aim treatment to the prostate, thereby reducing radiation delivery to the adjacent bladder and rectum. Using these technologies allows physicians to deliver a higher radiation dose directly to the prostate resulting in more frequent cures with fewer side effects.
Patients who develop a recurrence of their cancers after prior radical prostate surgery can be effectively treated with radiation therapy delivered to the pelvic region once occupied by the prostate. Postoperative radiation therapy is also delivered with IMRT and IGRT.
Brachytherapy: Siteman also was the first medical center in the region to perform brachytherapy, or radioactive seed implantation, for prostate cancer. In this technique, radiation oncologists insert small “seeds” containing radioactive material throughout the prostate under ultrasound guidance. This technique, known as low dose rate (LDR) brachytherapy, emits radiation for several weeks then remains permanently and harmlessly in place.
Another brachytherapy technique, known as high dose rate (HDR) brachytherapy, involves the temporary placement of a radioactive source in the prostate gland.
Proton Beam Therapy: The S. Lee Kling Proton Therapy Center at the Siteman Cancer Center is the only proton therapy center located in Missouri and the surrounding region. It houses the world’s first compact proton beam accelerator. Radiation oncologists and physicists here helped evaluate the system and developed the patient protocols and quality standards for this advanced technology.
Proton beam therapy’s main advantage is being able to control radiation beams by depth, shape and the amount of radiation given. In other external radiation therapies, radiation beams pass through a patient to a defined location and then exit the body on the other side, leaving deposits of radiation all along their path. Because proton therapy allows for depth control, the majority of radiation is held until the beam hits the precise area targeted, and little to no radiation is delivered past the tumor. This treatment is ideal for patients with solid tumors that are located near sensitive structures or tissues, such as the bladder or rectum. Proton therapy can be used alone or it can be used in combination with other radiation therapies and/or hormone therapy. Your doctor can determine if you are an appropriate candidate for proton therapy and which clinical studies are available.
Chemotherapy is not used when prostate cancer has not spread. It does play a role in metastatic disease when the cancer has spread outside the prostate gland. The standard approach involves hormonal therapy followed by chemotherapy.
Recently, several new drugs have increased the options for physicians treating patients with prostate cancer. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. It can be given before or after surgery and in conjunction with radiation or by itself.
Washington University Physicians at Siteman use newer drugs, including new hormonal and biological therapies, to fight prostate cancer. Some of these therapies take away cancer cells’ ability to spread through new tissues or form new blood vessels. They also have pioneered studies of effective chemotherapy for patients with advanced prostate cancer. For patients who have failed standard therapy and are looking for experimental approaches, Siteman offers a range of chemotherapy clinical trials.
Hormonal therapy: Because male sex hormones can cause prostate cancer to grow, hormonal therapy blocks hormone production to slow the cancer.
Biologic therapy: These drugs use the patients’ immune systems to fight the prostate cancer.
Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and may be available at Siteman before many other treatment facilities have access to them.