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Prostate Cancer Treatment

Prostate Cancer Treatment | Orlando Prostate Cancer Treatment Options

Prostate cancer treatment comes in many different forms, and each has their own benefits and drawbacks. Physicians and patients alike must weigh many varying factors when determining the best treatment option for the patient. The following factors play a very important part in the equation of finding the optimal treatment:

  • Age
  • Gleason Score (measure of aggressiveness)
  • PSA (Prostate-Specific Antigen)
  • Lifestyle and Quality of Life

After carefully looking at all of these aspects, your physician can more aptly provide you with the proper treatment. However, after the prostate cancer treatment has been determined, what sort of procedures can be performed?

HIFU (High Intensity Focused Ultrasound)

HIFU for prostate cancer is a state-of-the-art technology, acoustic ablation technique, that utilizes the power of ultrasound to destroy deep-seated tissue with pinpoint accuracy for treatment of prostate cancer. Though it's still a relatively new procedure, our very own Doctor Lotenfoe is well versed in the procedure, and can help any patient who fits into this category of treatment. How exactly does the HIFU procedure work, and how does it help fight prostate cancer? HIFU focuses sound waves in a targeted area which rapidly increases the temperature in the focal zone causing cancer tissue destruction.

Due to the nature of this prostate cancer treatment, and how precise it actually is, it reduces the risk of common side effects such as impotence and incontinence that may come with other treatment methods.

HIFU is a 1-3 hour, one-time, procedure that is performed on an outpatient basis under spinal or epidural anesthesia. Unlike radiation, HIFU is non-ionizing so it can be repeated if necessary without causing any damage to the healthy tissue inside or around the prostate. This means that HIFU can also be used as a salvage technique if other prostate cancer treatments do not succeed in removing cancerous tissues from the area.

Cryotherapy

Another form of prostate cancer treatment is cryoblation, which is a unique form of cryotherapy specifically for the prostate. This procedure involves controlled freezing in the prostate gland region with the purpose of destroying cancerous tissue. The damage that occurs with freezing happens at several levels:

  • Molecular level
  • Cellular level
  • Whole tissue structure

Due to the levels that this procedure goes to, it ensures that the cancerous area of the prostate gland is well and sufficiently removed. In addition to the cancerous cells, the surrounding connective tissue (or stroma) and the blood vessels that are the smallest (capillaries) are also damaged. While this may sound unpleasant, it actually is beneficial as it means that there's a lessening in the blood supply which slows the growth of cancer.

The prostate cancer treatment itself begins by placing hollow needles in predetermined locations in the prostate under ultrasound guidance. Argon gas is then injected through the needles, which results in sub-zero temperatures entering the area. This gas then causes cellular destruction in a controlled fashion, and the process is repeated at least twice in order to achieve complete cancer cellular destruction. While it's still considered a minimally invasive surgery, it is still a major operation, and as a result may require an overnight hospital stay. Part of the downside to cryotherapy is that 90% of patients treated are considered impotent, and 10% are incontinent.

Radical Prostatectomy

Yet another form of prostate cancer treatment is radical prostatectomy, which is a surgery that removes the entire prostate gland and some of the tissue around it. This procedure may be done by open or laparoscopic surgery. Open prostatectomy usually takes one to two hours, while a laparoscopic prostatectomy might take upwards of eight hours. Recovery time for this procedure requires at least one to seven days stay in the hospital, and a catheter is worn after the procedure for up to three weeks. In order to have full mobility and have a complete recovery, expect upwards of eight weeks. As with cryotherapy, impotence rates and incontinence rates are increased, with impotence reaching 50%-80% and incontinence reaching between 10%-20%.

Radiation Therapy

We specialize in two different primary types of radiation therapy: External Beam Radiation Therapy (or EBRT) and brachytherapy or seed implants. EBRT is typically recommended for men who have a prostate volume that's less than 60 grams, which is why we go through the initial process of figuring out more details about you personally before suggesting a particular prostate cancer treatment method. This procedure requires eight weeks of radiation directed at the cancerous cells from outside the body. Meanwhile, brachytherapy is radiation therapy that is transmitted by miniscule radioactive pellets or seeds placed inside the prostate.

While radiation therapy has improved significantly in recent years, it's still the case that radiation can't be precisely controlled, which means that the radiation can extend beyond the therapeutic field and affect neurovascular bundles and urinary sphincter, causing permanent damage that leads to impotence and incontinence. As many as 80% of men find they have become impotent after radiation therapy, while 10% to 20% of radiation patients suffer from incontinence.

Hormone Therapy

The last prostate cancer treatment that we have is hormone therapy, which reduces the amount of testosterone in the blood and thus depriving the prostate of the proper stimulus. This procedure does extend life and delay disease progression, but it's also found that the prostate cancer tissue can become highly resistant to the treatment over a period of months or years. As with other prostate cancer treatment methods, hormone therapy is not without side effects. Possible side effects include:

  • Hot flashes
  • Breast tenderness and growth of breast tissue
  • Osteoporosis
  • Anemia
  • Decreased mental acuity
  • Loss of muscle mass
  • Weight gain
  • Fatigue
  • Decrease in HDL cholesterol
  • Depression

These side effects aren't guaranteed, but they are possible, so we want to sufficiently notify you of the possibilities.

Doctor Lotenfoe is a premier urologist in the Orlando area, but he specializes in many forms of prostate cancer treatment. Depending on your situation, one of the above treatment methods would be chosen, but we highly advise coming in for a consultation so that we can discuss further and figure out your specific needs. 

 For further comparison of HIFU for prostate cancer versus other treatment options, please visit our Prostate Cancer Treatment Options page.

Additional information may also be found in our Video Library as well as our Resources page.

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