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Education
For patients and/or
spouses and their family members please visit the following support
website Patient Guide to Prostate Cancer
The prostate is a gland in the male reproductive system and is the size of a small walnut. The prostate organ is located between the urethra (carries urine outside of body) and the bladder (stores urine). The main function of a prostate is to produce the fluid for semen which transports sperm. The prostate itself consists of muscular and glandular tissues.
Prostate Cancer is staged according to the extent of cancer spread:
Each man diagnosed with prostate cancer is confronted with a decision of which treatment option to have. Judgments are based on the individual patient, his overall health and grade of the disease. How Prostate Cancer is Treated? Watchful waiting has been advocated as a reasonable approach for some men as prostate cancer, left untreated, grows quite slowly. Again, judgments need to be based on the expected life span of the individual patient, his overall health, and the grade of the disease. But in especially elderly men, watchful waiting is reasonable when the prostate cancer is low grade. Watchful waiting is NOT an alternative for everyone. Please consult your physician for more information on watchful waiting. Radical Prostatectomy is the surgery performed for the treatment of localized prostate cancer. Radical Prostatectomy has been considered to be the GOLD standard for treatment of prostate cancer . The surgeon makes an incision in the lower abdomen, (retropubic) or depending on the surgeon, behind the scrotum, (perineal). The entire prostate and the seminal vesicles are then removed. This surgery is recommended by surgeons when the cancer is confined within the tissues removed during radical surgery. Radical Prostatectomy can cure localized cancer but a strong post-operative follow up on PSA levels should be conducted to detect if small amounts of cancer were left behind. Larger tumors do not respond as well to surgery since they may extend outside the margin of the tissue removed at surgery. Risks and Side Effects of Radical Prostatectomy: Incontinence and Impotence Incontinence: Sometimes patients experience some degree of incontinence (urine leakage) for up to 2/3 months following the radical surgery. A majority of men eventually regain good control of urinary functions after surgery. Impotence: Impotence can be a potential side effect of the Radical Prostatectomy. A surgery technique called nerve-sparing surgery was pioneered by Dr. Pat Walsh of John Hopkins University in which the nerves are spared during surgery. The latest technology to assist surgeons in mapping the location of these vital nerves is the CaverMap Surgical Aid. The nerves bundles responsible for erectile function lie close to the prostate and the location of the nerves can vary given the anatomical differences between patients. CaverMap allows the surgeon to place a sensored probe tip in the body cavity during prostate removal. The surgeon is then alerted with a series of both audio and visual beeps when he has located a nerve responsible for erections. A tumescence sensor is also placed on the penis to monitor blood flow (penis becomes engorged) and this too signals the surgeon he is on a vital nerve. This helps the surgeon map out and cut around the nerve, sparing it of damage, and helping to preserve erections in the patient post-operatively. 100 of the top institutions nationwide use the CaverMap Surgical Aid to assist them in their nerve sparing techniques. To obtain a list of institutions in your area please see CaverMap Surgical Aid Sites 2000. Successful treatment of erectile function in a patient after prostatectomy with Sildenafil citrate Viagra® may depend on preservation of nerve bundles.1 See www.viagra.com. Please consult your physician for more information on radical prostatectomy and CaverMap. The term "brachy" comes from the Greek word for short distance. Brachytherapy is a cancer-killing treatment using radiation at a very short distance from the tumor. Radioactive seeds or sources are placed in the tumor itself, or in the surrounding tissue to provide a lethal dose of radiation. Brachytherapy is the most exact method for giving radiation therapy. It can be used to treat many types of cancers, including prostate. There are different types of radiation seeds used, two types are iodine-125 and palladium-103. Prostate cancer is well suited to
brachytherapy. The prostate gland is tucked under the bladder and in
front of the rectum, and it is extremely important that the radiation be
focused on the prostate gland to avoid serious side effects. High Dose Radiation temporary brachytherapy involves the placement of small plastic catheters which are inserted into the prostate gland. A computer-controlled machine pushes a single highly radioactive seed into the catheters one by one usually, several such treatments are given over a period of hours or days. Computers control how long a single seed can remain in each of the catheters, therefore radiation dose is easily controlled in different regions of the prostate. Please consult your physician for more information about Brachytherapy. Hormone therapy for prostate cancer is based on the fact that many prostate cancers will only grow in the presence of male hormone (testosterone). In such cases, the cancer may be shrunk for long periods of time (and will stop growing) if the patient's testosterone level is suppressed. This is considered hormonal treatment. Years ago it was found that patients who had metastatic prostate cancer to the bones would often go into remission if only their testicles were removed. Testicles are the major source of male hormone in the body, so removing them is an effective method of lowering the testosterone level. The reason it is less common is the many psychological reasons that deter men from considering such an approach. In response to that, various medical approaches have been developed to deprive production of testosterone in the body. The earliest method involved giving estrogen (female hormones) which would suppress male hormone production by a feedback mechanism from the pituitary gland (gland in the base of the brain) which controls the testicles testosterone production. The method is simple and inexpensive, but has reported several side effects. More recently injectable medications have been shown to be just as effective as orchiectomy in dropping hormone levels down and controlling the cancers. Other medications such as Casodex are sometimes added for an additional boost to the hormone control mechanism. Hormone therapies are usually reserved for patients who have evidence of spread of their cancers to other parts of the body, or who have had failure of another treatment for their cancer. Hormonal therapy is also sometimes used to temporarily shrink the cancer to facilitate another treatment approach such as i.e. brachytherapy. Please consult your physician for more information about Hormone therapy. External beam radiation involves the use
of x-rays or gamma rays to eradicate malignant cells. This treatment has
been around for almost 100years. The X-rays penetrate the
body tissue and deliver radiation to the cancer cells, usually seated
deep inside the body. Use of X-rays do have side effects, because
normal tissues and organs also are affected by these penetrating
radiations. To reach the cancer cells, often, the x-rays have to
penetrate through normal surrounding tissues. Conformal radiation
therapy, or otherwise called three-dimensional conformal radiation
therapy (3D CRT) is now the standard of care and approaches the cancer
from several angles to minimize exposure and thereby damage to adjacent
normal tissues.* "Cryoablation" is the controlled freezing of the prostate gland in order to destroy the cancerous cells. Cryosurgery of the prostate is for treating prostate cancer without the trauma of surgery. Minimal blood loss, little discomfort, and a single day in the hospital are the benefits of this approach. However cryosurgery is still a treatment method that is undergoing testing to improve results. The treatment involves the placement of
five needles into the prostate through the perineal skin. The
patient is under anesthetic. Needles are placed with guidance
transrectally. Through a series of needles, and plastic straws
liquid nitrogen is then pumped into each of the cryoprobes. The
end of each cryoprobe gets extremely cold and the entire prostate is
frozen. Please consult your doctor for more information
regarding cryosurgery.
References 1
Treatment of Erectile Function After Radical Prostatectomy Prostate Health Council c/o American Foundation for Urologic Disease afud.com Cancer Treatment Centers of America,
Reference data from Brachytherapy.com Article by Duke K. Bahn, MD. Part of the
Cancer News on the Net. University of Massachusetts Medical
Center. *Exerpts from http://www.rado.uic.edu/vijay/#conformal
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Prostate Cancer is the most common cancer
in American men today. 1 out of 10 men will develop prostate
cancer at some stage in their lives. Prostate Cancer is the second
leading cause of cancer deaths among men in the U.S., however, it can be
treated successfully if detected early on. 
Prostate Cancer is the malignant tumor
that begins to grow within the outer layers outside of the prostate. As the
tumor grows, it then can spread into the inner part of the prostate.
Localized prostate cancer is cancer that is confined within the prostate
and has not spread. Prostate cancer can spread (metastasize) first
locally in the tissue, then the seminal vesicles (sac-attached to
prostate) and in advanced cancer can spread to lymph nodes or bones.
