Prostate Cancer Treatment
All of our urologists at Urology Specialists of Oregon have expertise in diagnosis and management of prostate cancer. Dr. Simmons has extensive experience and expertise in robotic prostatectomy. Since 2004 he has been involved in over 400 minimally-invasive and robotic prostatectomy surgeries. He has conducted over 200 of these surgeries since his arrival in Bend. His outcomes for these surgeries have been published and rival those of some of the best surgeons nationwide.
How is prostate cancer detected?
Prostate cancer is detected with either a blood test called “PSA” or with a prostate exam. PSA detects a protein in the blood that is produced by prostate tissue. PSA values depends on a man’s age, but a level higher than 4ng/dL is generally considered abnormal. It is possible for men with prostate cancer to have an abnormal exam and a “normal” PSA. Likewise, men can have a normal exam and an abnormal PSA. That is why it is very important to conduct both screening tests. If either test is abnormal then a biopsy is conducted. Results of the biopsy determine what course of treatment is needed.
What does the biopsy tell me?
The biopsy pathology report provides information about the “Gleason score,” the amount of cancer and the location of the cancer. This information along with your PSA level and individual health status factors into the decision of how to treat the disease. Biopsy results, PSA, age and other health factors are evaluated in order to figure out how to manage the disease.
Why treat prostate cancer?
The goal of treating prostate cancer is to prevent death due to metastatic disease. In a 50 year old healthy male treatment is recommended. It is likely he will live another 2-3 decades, and during such a long period the risk of developing metastatic prostate cancer is high. In contrast, for a man in his mid-70’s with heart disease and diabetes not treating the cancer may be the best approach. This patient is more likely to die within 10 years from other illnesses. The decision to treat is complex and involves an in-depth discussion with your urologist.
If I have low risk cancer how dangerous is it?
Low risk prostate cancer (Gleason 6 and PSA <10) usually progresses very slowly and poses low risk for metastasis. Most men with low risk disease opt for treatment, and cancer control is excellent. Select patients choose to undergo active surveillance. It involves a repeat biopsy every 18-24 months. If cancer detected on a repeat biopsy is more severe than on the initial biopsy then the patient moves forward with treatment. The advantage of this approach is that some men are spared the side effects of treatment. The disadvantage is that there may be disease present that the biopsy didn’t detect, and there is risk of disease progression during the surveillance period. Close follow-up in this process is critical.
What are my options for prostate cancer treatment in Bend, OR?
There are three time-tested methods for treating prostate cancer. The first treatment is surgical removal of the prostate or “prostatectomy.” Two additional options involve radiation and are termed interstitial brachytherapy (also known as “seed therapy”) and external beam radiotherapy. Safety and effectiveness of surgery and radiation treatments are supported by decades of clinical studies. Other less well-studied treatment methods include cryoablation (a.k.a., “freezing”) and HIFU (High-intensity focused ultrasound). These treatments are reported to have fewer side effects than surgery or radiation, but their effectiveness in curing cancer is not completely understood.
What does surgery for prostate cancer involve?
Prostatectomy involves removal of the prostate, the seminal vesicles, and in some cases the pelvic lymph nodes. The advantage of surgery is that it affords the highest likelihood for cure, and allows the pathologist to accurately assess the severity of disease. Disadvantages include hospitalization for 1-2 days, need for a catheter for 10-14 days after surgery, and possible side effects of incontinence and erectile dysfunction. Typical full recovery after surgery is 4-6 weeks.
What are chances of incontinence after prostatectomy?
Most men in the immediate weeks after surgery will have a small degree leakage with activity, coughing or sneezing. By 6-12 months the amount of leakage tends to be minimal. Continence improves for up to 18 months after surgery. If bothersome incontinence persists after 18 months it can be effectively treated. Men are instructed to perform Kegel exercises which help strengthen the pelvic floor muscles. Formal pelvic floor physical therapy is also available locally in Bend.
What are my chances of regaining erections after surgery?
This is a complicated topic and depends on several factors such as age, presence of erectile dysfunction before surgery, and whether a “nerve-sparing” was able to be conducted. In men with good erections before surgery who undergo nerve-sparing prostate surgery, 70% will regain good function. The other 30% will have a decrease in function that can usually be managed with medication. In men with pre-existing erectile dysfunction, or in those without nerve-sparing the success rate tends to be lower.
What does External beam radiotherapy involve?
External beam radiotherapy (EBRT) involves radiating the prostate using a focused beam of energy. Some facilities use electrons, others use protons. Typically, patients receive a radiation dose daily for 30-50 days. This is usually combined with hormone deprivation therapy (medical castration to lower testosterone levels) for 3 months before and up to 2 years after radiation treatment. The main advantage of EBRT is that it provides effective control of intermediate and high risk cancers. The main disadvantage is that it has side effects similar to brachytherapy. Similar to brachytherapy, the risk for incontinence is low, and risk for erectile dysfunction is high.
How do I know if my prostate cancer is cured?
After surgery the PSA should decrease to undetectable levels and should remain there. An increase in PSA after surgery is termed “biochemical recurrence.” When the PSA reaches a level of 0.2 on 2 consecutive tests, then it is assumed that the cancer has returned. Imaging studies are conducted to make sure that there is no metastasis. If this is the case, and the disease is confined to the pelvis, then it is often possible to successfully treat this with radiation.
After radiation the PSA usually fluctuates for 12-18 months but then reaches a steady level. The lowest level the PSA reaches is called the “nadir,” and several different methods are used to determine when a rise in PSA after radiation signals recurrent disease. If PSA increases then imaging studies are done to rule out metastatic disease. If disease is confined to the prostate then the most effective means to treat it is surgery. Unfortunately in this setting the risk of incontinence and impotence is almost 100% due to radiation effects on tissue health.
If you have any questions, contact Urology Specialists of Oregon at (541) 322-5753.
Outcomes and Complications of Robotic-assisted Laparoscopic Prostatectomy in a Community Hospital
MN Simmons, M Fitts, T Krigbaum, AD Neeb
UROLOGY 96, 141-141
A practical guide to prostate cancer diagnosis and management
RK BERGLUND, JS JONES
Cleveland clinic journal of medicine 78 (5), 321
Combined androgen blockade revisited: emerging options for the treatment of castration-resistant
MN Simmons, EA Klein
Urology 73 (4), 697-705
Natural history of biochemical recurrence after radical prostatectomy: risk assessment for secondary
MN Simmons, AJ Stephenson, EA Klein
European urology 51 (5), 1175-1184