Urologic Cancer

Prostate Cancer

Signs and Symptoms
Diagnosis
Treatment

Treatment

Decisions about prostate cancer treatment involve many factors. Prostate cancer may have a prolonged course in some patients and may progress rapidly, requiring aggressive treatment, in others. Some patients, especially the elderly or those with other medical conditions, may die with prostate cancer rather than of prostate cancer.

Treatment may involve watchful waiting, surgery, radiation therapy or hormonal therapy. Some patients receive a combination of therapies. In addition, our doctors are studying other methods of treatment to find out whether they are effective against this condition.

Watchful Waiting

Watchful waiting may be suggested for some men who have prostate cancer that is found at an early stage and appears to be slow growing. Watchful waiting may be advised for older men or men with other serious medical problems. For these men, the risks and possible side effects of surgery, radiation therapy or hormonal therapy may outweigh the possible benefits.

Surgery

Surgery is a common treatment for early stage prostate cancer. The doctor may remove all of the prostate, performing a type of surgery called radical prostatectomy, or only part of it.

• Radical Prostatectomy -- In many cases of prostate cancer, radical prostatectomy is the preferred treatment. Evolution in the surgical technique over the past 20 years has improved the ability to cure the cancer while reducing potential complications such as blood loss, incontinence and erectile dysfunction. Surgeons at UCSF Medical Center have extensive experience with radical prostatectomy and have achieved excellent results in all aspects of the associated surgical outcomes.

• Robotic Radical Prostatectomy -- Minimally invasive, laparoscopic prostatectomy uses a the state-of-the-art robotic system that provides a magnified, three-dimensional view during the operation while surgeons to use its robotic arms. With robotic surgical technology, our experienced surgeons achieve successful outcomes similar to open prostatectomy with the additional benefits that include less blood loss during surgery, decreased pain after the operation and faster recovery.

In some cases, the doctor can use a new technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

Radiation Therapy

Radiation therapy, also called radiotherapy, uses high-energy X-rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It can affect cancer cells only in the treated area. In early stage prostate cancer, radiation can be used instead of surgery, or it may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages, it may be given to relieve pain or other problems.

Radiation may be directed at the body by a machine, called external radiation, or it may come from tiny radioactive seeds placed inside or near the tumor, called internal or implant radiation and brachytherapy. Men who receive radioactive seeds alone usually have small tumors. Some men receive both kinds of radiation therapy. For external radiation therapy, patients go to the hospital or clinic, usually five days a week for several weeks. Patients may stay in the hospital for a short time for implant radiation.

Hormonal Therapy

Hormonal therapy prevents cancer cells from getting the male hormones they need to grow. It is called systemic therapy because it can affect cancer cells throughout the body. Systemic therapy is used to treat cancer that has spread. Sometimes this type of therapy is used to try to prevent the cancer from coming back after surgery or radiation treatment.

There are several forms of hormonal therapy:

• Orchiectomy is surgery to remove the testicles, the main source of male hormones.

• Drugs known as luteinizing hormone-releasing hormone (LH-RH) agonists can prevent the testicles from producing testosterone. Examples of these drugs are leuprolide, goserelin and buserelin.

• Drugs known as antiandrogens can block the action of androgens, a male sex hormone. Two examples are flutamide and bicalutamide.

• Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.

Reviewed by health care specialists at UCSF Medical Center.
Last updated April 19, 2007