Prostate Cancer TreatmentsThere are numerous treatments for localized prostate cancer and each has its own benefits and deficiencies. Patients and their physicians must weigh many factors when determining the best treatment option. Age, Gleason score (measures aggressiveness), PSA, lifestyle and quality of life all may be factors in the equation of finding the optimal treatment. Treatments available include: - High Intensity Focused Ultrasound (HIFU)
- Radical prostatectomy
- Radiation therapy
- Hormone therapy
- Cryotherapy
The information below is provided for general information purposes only and is not intended to replace sound professional medical advice and care. All treatment options and potential outcomes and complications should be discussed with a qualified health care provider. Some patients choose no treatment at all, called watchful waiting or active surveillance, because of the possible effects of treatment on quality of life. High Intensity Focused Ultrasound with the SonablateSonablate HIFU is a minimally invasive treatment option for prostate cancer that uses a transrectal probe to focus ultrasound waves in the prostate. At a very precise and targeted location, the temperature is rapidly elevated which causes tissue destruction. During HIFU, typically the entire prostate is treated or ablated. Radical ProstatectomyA radical prostatectomy is surgery to remove the entire prostate gland, and some of the tissue around it, and may be done by open or laparoscopic surgery. It is used most often if the cancer is not thought to have spread outside of the gland (stage T1 or T2 cancers). Radiation TherapyRadiation therapy uses high-energy rays or particles to kill cancer cells. Radiation is sometimes used as the initial treatment for low-grade cancer that is still confined within the prostate gland or that has only spread to nearby tissue. Two main types of radiation therapy are used: external beam radiation and brachytherapy (internal radiation). CryotherapyCryosurgery (also called cryotherapy or cryoablation) is used to treat localized prostate cancer by freezing it. In this approach, several hollow probes (needles) are placed through the skin between the anus and scrotum (the perineum). The doctor guides them into the prostate using transrectal ultrasound (TRUS). Very cold gases are passed through the needles, creating ice balls that destroy the prostate gland. Hormone TherapyHormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy. The goal is to reduce levels of the male hormones, called androgens, in the body. The main androgens are testosterone and dihydrotestosterone (DHT). Androgens, produced mainly in the testicles, stimulate prostate cancer cells to grow. Lowering androgen levels often makes prostate cancers shrink or grow more slowly. However, hormone therapy does not cure prostate cancer. Again, the information is provided for general information purposes only and is not intended to replace sound professional medical advice and care. All treatment options, potential outcomes and complications should be discussed with a qualified health care provider. Prostate Cancer Treatment Comparison Chart
 General references
Thompson I, Thrasher JB, Aus G et al. Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update. J Urol 177:2106-2131, 2007
Prostate Cancer Treatment Guide™ http://www.prostate-cancer.com/
Prostate Cancer Treatments, Prostate Cancer Institute Online
http://www.prostate-cancer-institute.org/prostate-cancer-treatment/prostate-cancer-treatment.html
HIFU
Uchida T, Ohkusa H, Yamashita H et al. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. Intl J Urol 13:228-233, 2006
Uchida T, Ohkusa H, Nagata Y et al. Treatment of localized prostate cancer using high-intensity focused ultrasound. BJU Int 97:56-61, 2005
Cryosurgery
Cooperberg M, Carroll P, Shinohara K. Prostate Cancer: Cryotherapy. http://www.emedicine.com/med/TOPIC3539.HTM
Mouraviev V and Polascik TJ. Update on cryotherapy for prostate cancer in 2006. Current Opinion Urol 16:152-156, 2006
Bahn DK, Lee F, Badalament R et al. Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer. Urology 60 (Suppl 2A):3-11, 2002
Han KR, Cohen JK, Miller RJ et al. Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience. J Urol 170:1126-1130, 2003
Long JP, Bahn D, Lee F et al. Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate. Urology 57:518-523
Lam JS, Shvarts O and Belldegrun AS. Cryotherapy for PCa: the next generation. Contemporary Urol 16:2-12, 2004
Radical Prostatectomy
Han M, Partin AW, Zahurak M et al.: Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer. J Urol 169: 517-523, 2003
Madalinska JB, Essink-Bot M-L, de Koning HJ et al. Health-related Quality-of-Life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. J Clin Oncol 19:1619-1628, 2001.
Potosky AL, Davis WW, Hoffman RM et al.: Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the Prostate Cancer Outcomes Study. J Natl Cancer Inst 96(18):1358-1367, 2004
Roehl KA, Han M, Ramos CG et al.: Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol 172:910-914, 2004
Ung JO, Richie JP, Chen M-H et al.: Evolution of the presentation and pathologic and biochemical outcomes after radical prostatectomy for patients with clinically localized prostate cancer diagnosed during the PSA era. Urology 60:458-463, 2002
Catalona WJ, Basler JW: Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy. J Urol 150 (3): 905-7, 1993.
External Beam Radiation Therapy
Madalinska JB, Essink-Bot M-L, de Koning HJ et al. Health-related Quality-of-Life effects of radical prostatectomy and primary radiotherapy for screen-detected or clinically diagnosed localized prostate cancer. J Clin Oncol 19:1619-1628, 2001.
Potosky AL, Legler J, Albertsen PC et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst 92:1582-1592, 2000.
Rosser CJ, Chichakli R, Levy LB et al. Biochemical disease-free survival in men younger than 60 years with prostate cancer treated with external beam radiation. J Urol 168:536-541, 2002.
Zietman AL, Chung CS, Cohen JJ et al. 10-Year outcome for men with localized prostate cancer treated with external radiation therapy: results of a cohort study. J Urol 171:210-214, 2004.
Brachytherapy
Grimm PD, Blasko JC, Sylvester JE et al. 10-Year biochemical (prostate-specific antigen) control of prostate cancer with 125I brachytherapy. Int J Radiation Oncology Biol Phys 51:31-40.
Potters L, Morgenstern C, Calugaru E et al. 12-Year outcomes following permanent prostate brachytherapy in patients with clinically localized prostate cancer. J Urol 173:1562-1566, 2005
Talcott JA, Clark JA, Stark PC et al. Long-term treatment related complications of brachytherapy for early prostate cancer: a survey of patients previously treated. J Urol 166:494-499, 2001
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