Download Prostate Cancer Treatment Options - California Pacific Medical Center

oncology services
Image-Guided Radiation Therapy (IGRT) coordinates the radiation treatment plan with 3D images to
enhance radiation beam accuracy on targeted
tumors. The high-resolution images produced by
the IGRT On-Board Imager™ enables clinicians more
precise treatment delivery and planning, improving
radiation beam accuracy by pinpointing tumor location with unprecedented speed. Increased precision
ensures targeted accuracy, avoiding surrounding critical
structures. A tighter tissue margin spares surrounding
healthy tissues and allows
a bigger radiation therapy
dose delivery rate directly to
the targeted tumor. A larger
radiation dose destroys
cancer cells more quickly
without increasing treatment side effects.
Tumors move during
radiotherapy due to biological reasons such as breathing, swallowing, and bladder filling. By combining
scanning and radiation equipment to produce real-time
images of the patient’s organs in treatment position at
treatment time optimizes accuracy and radiotherapy
precision. Using the IGRT On-Board Imager, we verify
tumor location prior to each treatment and make any
needed adjustments.
Watchful Waiting or Active
Surveillance
Close observation without treatment may be an appropriate therapeutic option for selected patients with
less aggressive, slow-growing tumors, low PSA level,
or men who are unsuitable for aggressive treatment.
To find a Sutter physician near you,
visit thedoctorforyou.com
or call 888-637-2762.
Hormone Therapy
Androgen deprivation therapy (ADP) lowers male
hormone levels and can often help shrink prostate
cancers or slow their growth. This treatment is a
stop-gap measure when patients are not candidates
for surgery or radiation therapy or can be used in conjunction with radiation treatments to try to shrink
a tumor prior to treatment.
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Copyright © 2010 California Pacific Medical Center. All rights reserved.
CAN-ProstateBrochure-2010
Prostate Cancer
Treatment Options
Prostate Cancer
Prostate cancer is the most common cancer in
American men today, and the second-leading cause
of cancer-related death. The most appropriate treatment
choice for prostate cancer depends on many factors,
including tumor volume and stage or extent of cancer,
the pathologic Gleason score*, prostate specific antigen
(PSA) level, and patient’s age and general health. Each
treatment option offers comparable results with varying
degrees of side effects. Patients are encouraged to consider both the predicted cancer control rates and sideeffect after each therapy when deciding a treatment
choice. Certain patients may not be candidates for one
or more of these treatment options. When diagnosed
with prostate cancer, men should discuss all treatment
options thoroughly with their physician.
* Gleason score: Using a scale of 6 to 10. The Gleason score is a powerful
tool for predicting how aggressive a tumor will be. The higher the Gleason
score, the more likely the tumor is to grow rapidly and spread (metastasize)
to other parts of the body.
Radical Prostatectomy
Surgical removal of the prostate gland has been the
most common prostate cancer treatment for many
decades. For men with cancer confined to the prostate
gland, this procedure offers excellent cancer control
rates and is well tolerated. Performed under general or
spinal anesthesia, the prostate and frequently the surrounding lymph nodes, are removed using a midline
incision below the belly button. A pathologist examines
the prostate gland and lymph nodes to ensure all the
cancer has been removed. In many cases, surgeons
perform nerve-sparing prostatectomies, to preserve
erectile function and continence. Modern surgical techniques reduce the length of hospitalization and recovery
time compared to older techniques, but patients usually
spend two-three nights.
Da Vinci Robotic Radical Prostatectomy is the
latest in minimally invasive approaches to remove the
prostate. Using the da Vinci robot, small “Band-Aid”
incisions are made in the low abdomen through which
surgical telescopes and the surgeon-controlled robotic
instruments are used to perform the surgery. Many surgeons feel that the enhanced visibility and fine control
of the da Vinci robot allows for a more delicate and precise operation. This is especially important when sparing
nerves to maintain erectile function and minimize blood
loss. The cancer cure rate is comparable to open surgery.
Most patients return to their normal activity within
one-three weeks.
Radiation Oncology
Prostate Brachytherapy involves ultrasoundguided placement of approximately 80 to 120
radioactive seeds (iodine-125) directly into the
prostate gland. Transrectal ultrasound (TRUS) guidance allows customization of the implant based on a
3D reconstruction of the patient’s exact prostate size
and shape. This sophisticated prostate radiation therapy
technique allows a high concentration of radiation to the
prostate gland, but avoids high doses of radiation to the
healthy surrounding tissues.
Brachytherapy is performed on an outpatient basis,
patients are able to leave the hospital within a few hours
postimplant and, in many cases, resume their normal
activities within a few days. Patients typically experience
a lower-than-average rate of impotence.
High-Dose-Rate (HDR) Brachytherapy usually
given as a treatment prior to external beam radiotherapy,
has become an accepted cancer treatment. HDR involves
surgically inserted hollow plastic catheters in the cancerous organ to deliver radiation treatment at any point
inside the catheter with millimeter accuracy, allowing the
most accurate delivery of radiation to an organ. The HDR
unit has a single radiation source of Iridium-192 welded
to a long wire controlled by computer-driven motor.
Patients typically receive one to 10 HDR treatments,
lasting approximately 45 minutes, spaced at least six
hours apart. Once the final HDR treatment is delivered,
the catheters are removed and the patient is discharged
home when appropriate.
External Beam Radiation Therapy uses some of the
newest technologies available, 3D conformal therapy and
intensity modulated radiation therapy (IMRT), to direct
and shape the radiation beams, maximizing radiation
dosage to the prostate, while minimizing radiation exposure to the surrounding healthy tissues.
IMRT is an advanced type of high-precision conformal
radiation using computer-controlled x-ray accelerators
to deliver 3D radiation beams conformed closely to the
shape of the tumor. This precise targeting enables physicians to control the intensity of the radiation beam dose
distribution within a given area. Multileaf collimators
or beam shaping devices can be turned on or off during
treatment, varying the radiation beam intensity across
the targeted field.
Radiation therapy is carefully planned using 3D
computed tomography (CT) with computerized dose
calculations to determine the dose intensity pattern that
best conforms to the tumor shape. IMRT combined with
3D CT, called inverse treatment planning, creates the
custom-tailored radiation dose consisting of several
hundred small beams of varying intensities that pass
through normal tissue without doing significant
damage, but converge to give precise doses of radiation
at the tumor site.
Cone Beam CT (CBCT) improves tumor targeting
using high-resolution, low-dose digital imaging in the
treatment room. This allows our radiation therapists to
confidently manage treatment and target tumor movement, before and during treatments. The use of kV image technology can result in lower patient radiation dose
and better image quality than megavoltage imaging.