What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease and to the individual person. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are the only center in the world to do MRI-based treatment planning. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. This allows us to make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
For more advanced disease, we have ongoing studies in which we combine novel hormonal therapy agents with radiation to achieve better results. Even the way we follow our patients after treatment is unique, with carefully sequenced MRI checks that give us opportunities to monitor patients extremely closely.
During Watchful Waiting Or Active Surveillance
If you choose observation or active surveillance, your PSA level will be monitored closely to help decide if the cancer is growing and if treatment should be considered.
Your doctor will watch your PSA level and how quickly it is rising. Not all doctors agree on exactly what PSA level might require further action . Again, talk to your doctor so you understand what change in your PSA might be considered cause for concern.
Surgery For Prostate Cancer
A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinci® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.
The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.
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How Prostate Cancer Staging And Risk Stratification Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:
Localized, meaning theres no indication that the cancer has spread beyond the prostate
Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue
Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
What Happens Between Appointments
Contact your doctor or nurse if you have any concerns or get any new symptoms or side effects between your follow-up appointments.
Its important to speak to them if youre concerned about anything dont worry about them being too busy.
You can get support or advice over the telephone, or they might bring forward the date of your nextfollow-up appointment.
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Patterns Of Postprostatectomy Psa Recurrence
Clinical observations have documented two distinct patterns of PSA recurrence. Most patients whose cancer recurs within 2 years of surgery and whose serum PSA rises rapidly develop clinical metastases, with or without local recurrences. On the other hand, patients whose serum PSA becomes detectable more than 2 years after surgery and who display a slow PSA rise present predominantly with local recurrences.4
Psa Levels And Prostate Cancer Relapse
For people with relapsed cancer, the threshold to determine relapse will change based on whether surgery or radiation was used to treat it:
- PSA levels drop to zero after surgery. The cancer has returned if PSA levels are over 0.2 nanograms per milliliter .
- PSA levels are low but present after radiation. A relapse has occurred when the PSA levels rise 2 points higher than the lowest score achieved after radiation.
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What Happens After Radiotherapy
After youve finished your radiotherapy, you will have regular check-ups to monitor your progress. This is often called follow-up. The aim is to:
- check how your cancer has responded to treatment
- help you deal with any side effects of treatment
- give you a chance to raise any concerns or ask any questions.
Your follow-up appointments will usually start two or three months after treatment. You will then have appointments every three to six months. After three years, you may have
follow-up appointments less often. Each hospital will do things slightly differently, so ask your doctor or nurse for more details about how often you will have follow-up appointments.
PSA test
The PSA test is a blood test that measures the amount of a protein called prostate specific antigen in your blood. You will usually have a PSA test a week or two before each follow-up appointment, so the results are available at your check-up. This can often be done at your GP surgery. PSA tests are a very effective way of checking how well your treatment has worked.
After treatment, your PSA level should start to drop. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA. But it could fall to about 1 ng/ml, although every man is different and your medical team will monitor your PSA level closely.
Treatment options after radiotherapy
Looking after yourself after radiotherapy
Radiation Therapy After Prostate Surgery Worsens Sexual Urinary Function
Radiotherapy after radical prostatectomy appears to be associated with worse sexual, urinary, and bowel function at 5 years compared with RP alone in men with localized prostate cancer , according to a new prospective study published in Urologic Oncology.
The timing of RT after RP remains controversial because its effects on sexual, urinary, and bowel function has not been thoroughly studied. The new data provide urologists with information they can discuss with patients.
In the Comparative Effectiveness Analysis of Surgery and Radiation study, investigators found that delaying RT for approximately 24 months after RP was associated with a smaller decline in sexual function than RT administered closer to the time of RP. Assuming no compromise in oncologic control, the findings suggest that allowing for an approximate 2-year recovery period after RP may be optimal for preserving erectile function.
Retrospective data on continence rates and sexual function after post-prostatectomy radiotherapy are conflicting, first author Heather L. Huelster, MD, of Vanderbilt University Medical Center in Nashville, Tennessee stated. This prospective study describes the potential harms of post-prostatectomy radiation on sexual, urinary, and bowel function, as well as the differential outcomes based on the timing of radiation.
Reference
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Testosterone is the primary male hormone and plays an important role in establishing and maintaining the male sex characteristics, such as body hair, muscle mass, sexual desire, and erectile function. Most men who are on hormone therapy experience at least some effects related to the loss of testosterone, but the degree to which you will be affected by any one drug regimen is impossible to predict. Side effects from testosterone-lowering therapies include hot flashes, breast enlargement or tenderness, loss of bone mineral density and fractures, increased weight gain , higher cholesterol, a higher risk of diabetes, and a slightly higher risk of heart problems like heart attacks and chest pains. Some men complain of mood problems and depression during this time as well. Dont be afraid to discuss these issues with your doctors. For all of these reasons, maintaining a healthy overall lifestyle is vital to doing well with hormonal therapies over time.
Who Will Help Me During My Imrt Treatments
Many people will help you with your IMRT treatment and care. This group of health care providers is often called your âradiation therapy team.â They work together to give you care that is just right for you. Your radiation therapy team includes a:
- Radiation oncologist. This is a doctor who uses radiation therapy to treat patients with cancer. Your radiation oncologist:
- Will decide how much radiation you will get for your prostate cancer treatment
- Plans how your prostate cancer treatment will be given
- Closely follows you during your prostate cancer treatment
- And, directs any care you need to help with any side effects you may have during and after your prostate cancer treatment
The radiation oncologist will work with the other doctors, nurses, and health care providers on your team. After your treatment is over, your radiation oncologist will see you for follow-up visits. At these visits, your radiation oncologist will find out how well the radiation worked to treat your prostate cancer and will help you with any side effects that you may have.
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How Does Radiotherapy Work
Radiotherapy aims to destroy prostate cancer cells without causing too much damage to healthy cells. External beam radiotherapy is high-energy X-ray beams targeted at the prostate from outside the body. These X-ray beams damage the cancer cells and stop them from growing and spreading to other parts of the body . Radiotherapy permanently damages and kills the cancer cells, but healthy cells can repair themselves and recover more easily.
Radiotherapy treats the whole prostate. It aims to treat all the cancer cells, including any that have spread to the area just outside the prostate. The treatment itself is painless but it can cause side effects that may cause you problems.
You may have radiotherapy to a wider area, including the nearby lymph nodes, if there is a risk that the cancer has spread there. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your pelvic area are a common place for prostate cancer to spread to. If you do have radiotherapy to a wider area, you will be more likely to get side effects.
For Hifu Focal Therapy
The general criteria for suitability are as follows:
In general, men with early to intermediate stage prostate cancer that is confined within the prostate gland, and have a Gleason score of 7 or less, and a PSA of less than 20, are likely to be suitable for HIFU Focal Therapy.
However, an individual assessment is made for each patient based on a detailed review of their clinical files and their personal priorities.
Beyond this initial criteria there is a need for the careful review of each patients case to make sure the objectives of cancer control and minimal side effects can be achieved. In order to do this our consultants will review all of your clinical records, MRI images and biopsy results to make an assessment of suitability.
Each case is reviewed by our multidisciplinary team to confirm suitability and to work with Dr Clare Allen to prepare a treatment plan.
The decision on suitability is made on clinical grounds but also takes into consideration the values and personal priorities of the patient.
High quality information leads to highly informed discussion , which leads to optimal diagnostics and treatment for each patient.
Mr Alan Doherty, Urological Consultant at The Focal Therapy Clinic
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If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
During Your Radiation Treatments
When its time for your treatment, your radiation therapists will bring you to the treatment room and help you onto the treatment table. Youll be positioned exactly how you were during your simulation. Your radiation therapists will do everything they can to make sure youre comfortable during your treatment. Then, theyll leave the room and start your treatment.
Breathe normally during your treatment, but dont move. Your radiation therapists will be able to see you on a monitor and hear you through an intercom during your whole treatment. Tell them if youre uncomfortable or need help.
Neither you nor your clothes will be radioactive during or after treatment. Its safe for you to be around other people.
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How We Approach Prostate Cancer Treatment At Ctca
When you come to CTCA for a diagnostic consultation or second opinion, your case is reviewed by a multidisciplinary team of genitourinary cancer experts before you arrive for your first appointment. This team may include a medical oncologist, a urologist or urologic oncologist and a radiation oncologist.
If we determine you need additional diagnostic evaluations, such as imaging or genomic testing, we schedule those procedures for you before your arrival.
Well also schedule appointments for you with our integrative care providers, who work to prevent and manage side effects of cancer and its treatment.
Together, we develop a treatment plan thats based on your unique needsusually within two to three days. Our goal is to give you and your caregivers a clear understanding of your options to empower you to make an informed decision about your care.
At CTCA, we strive to treat our patients as we would want our own loved ones to be treated: with compassion, dignity and respect. Its the basis of our foundation, and we call it the Mother Standard® of care.
Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
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Barry & Jackies Story
When Barry was diagnosed with prostate cancer the treatment options he was given were unappealing. Jackie decided to do some independent research and found The Focal Therapy Clinic. Barry has now been treated successfully with HIFU Focal Therapy.
Jackie believes that although Barry is 75 he should not be pushed towards hormone/radiotherapy treatment as he has many years of active healthy life ahead of him.
Barry is a patient of The Focal Therapy Clinics Raj Nigam.
Side Effects Of Treatment
Treatments for prostate cancer can cause side effects, which might carry on after your treatment has finished. Some side effects can even start several months or years after treatment finishes.
Side effects will affect each man differently you may not get all the possible side effects from your treatment.
Read more about:
Managing side effects
Side effects can affect your day-to-day life, but there are treatments for them, as well as things you can do to manage them yourself. Its important to speak to your doctor, nurse or GP about them.
If youre having problems with a side effect, you might have a meeting with your doctor or nurse to work out what support you need. They may refer you to someone who can give you more advice and support.
Read more about managing the side effects of prostate cancer treatment.
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