The Sperling Prostate Center Advantage
Our philosophy is to match the treatment with the disease. Our BlueLaser 3T mpMRI-Guided Biopsy is the most responsible and accurate way to know your disease before making a treatment decision. We help patients avoid the risk of under-treating aggressive disease, or over-treating insignificant disease that can safely be monitored. We pride ourselves on having attained international recognition for excellence in real-time MRI-guided prostate cancer diagnosis.
If BlueLaser 3T mpMRI detects cancer, a biopsy is essential because prostate cancer may not show early symptoms, though certain warning signs indicate increased prostate cancer risk:
- An elevated or rising PSA blood test result
- An abnormal digital rectal exam
- A family history of prostate cancer or breast cancer
- Being of African-American descent
- Exposure to certain cancer-causing toxins, e.g. Vietnam vets exposed to Agent Orange
- In later stages, prostate cancer may show symptoms such as urinary difficulties, blood in urine, pelvic or back pain, and bone pain. See a doctor if any of these symptoms occur.
Study And Patient Characteristics
Three thousand three hundred sixty three records were identified, and 25 studies were finally included in this systematic review and meta-analysis . Due to a lack of data, 4 studies cannot be meta-analyzed, so we only presented the results of QoL in these studies. The flowchart of study inclusion was shown in Fig. . In total, there were 21 retrospective studies, 3 prospective studies, 1 RCT study published between 2006 and 2019. The median age was 58.271.8years for the RP group and 58.175.0years for the RT group. The median follow-up ranged from 23.89months to 15years. The characteristics of all included studies were shown in Table . Although the definitions of high-risk varied in each trial, most of them were consistent with the NCCN or DAmico criteria. Detailed comparison data can be found in Additional file 1: Table .
Fig.1
It seemed that EBRT+BT had similar or even better survival benefit than RP. RP showed obvious inferiority on CSS compared to EBRT+BT, and no significant difference between the two subgroups was observed on OS . As for other outcomes, Kishan and colleagues reported EBRT+BT was associated with longer MFS than RP .
Overall, most patients received EBRT in the included studies. Although RP was more beneficial to survival than EBRT, it was not as good as EBRT in PSA control, and the survival benefit of RP would no longer exist once EBRT was combined with BT.
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.
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Surgery Vs Radiation For Prostate Cancer
Prostate cancer is common cancer thats affecting men. If you happen to be diagnosed with prostate cancer then you might be wondering about the best treatment methods to follow.
The most common type of cancer treatments includes radiation and surgery. Early diagnosis of any cancer is very important because it helps minimize the risks and invasive procedures that are used when the cancer is advanced.
Localized prostate cancer means that it has not spread to other parts of your body and therefore it can be safely removed and you be cured of prostate cancer. If your cancer is not acute your physician will present you with about three treatment options when is radiotherapy, surgery, or active surveillance.
Men are eager to know the best treatment type for their prostate cancer. Note that there is a misconception that only one option is the best or safer. Both radiation therapy and surgery can be used to treat prostate cancer and achieve the desired results. The best thing about prostate cancer is that it spread slowly so men have some time to think of the options to go for.
Tools To Help You Decide
The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men whose prostate cancer hasnt spread.
It cant tell you exactly what is going to happen in the future, but it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.
To be able to use the tool you need to know the following about your cancer:
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What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer
Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.
There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective
Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.
Radiation Therapy For Prostate Cancer
Radiation therapy techniques have improved over the years. More precise radiation delivery techniques are designed to help spare normal tissue from exposure and reduce the severity of side effects. In addition to the external delivery of radiation, we now also have internal delivery options. In some cases, courses of radiation treatment may be more intense and shorter in duration.
The development and use of hydrogel spacersgel thats inserted between the prostate and the rectummay also reduce damage to tissue surrounding the prostate during radiation, which in turn helps to reduce treatment-associated side effects.
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Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.
Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
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Some Things To Consider When Choosing Among Treatments
Before deciding on treatment, here are some questions you may want to ask yourself:
- Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects?
- Would you be comfortable with watchful waiting or active surveillance, even if it means you might have more anxiety and need more frequent follow-up appointments in the future?
- Do you need to know right away whether your doctor was able to get all of the cancer out ? Or are you comfortable with not knowing the results of treatment for a while if it means not having to have surgery?
- Do you prefer to go with the newest technology , which might have some advantages? Or do you prefer to go with better proven treatments that doctors might have more experience with?
- Which potential treatment side effects might be most distressing to you?
- How important for you are issues like the amount of time spent in treatment or recovery?
- If your initial treatment is not successful, what would your options be at that point?
Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the âwrongâ one. In many cases, there is no single best option, so itâs important to take your time and decide which option is right for you.
Survival Outcomes By Treatment Strategies
As shown in Table and Figure , patients treated with EBRT + BT had significantly better cancerspecific survival, compared with patients treated with surgery or EBRT alone . No difference was found between EBRT and surgery by CSS outcome. When allcause mortality is considered, surgery had a significantly better OS than EBRT and a similar OS as EBRT + BT . These results suggested substantially elevated competing causes of death other than prostate cancer in patients treated with radiation over time. We then examined if salvage RT impacted the surgery vs RT comparisons by removing salvage RT patients from the surgery group. The conclusions were not substantially changed, although the statistical significance was lost in comparison of cancerspecific mortality between EBRT + BT and surgery .2). Since patients who forwent prostatectomy for RT were more likely to be older and susceptible to other causes of death, we performed stratified analyses by age . In patients 65 years, EBRT was significantly inferior to surgery in both cancerspecific mortality and allcause mortality. In patients > 65 years, EBRT was still inferior to surgery in allcause mortality, but EBRT and EBRT + BT showed a nonsignificant reduced cancerspecific mortality compared with surgery. When combined, RT was statistically significantly associated with a better cancerspecific mortality .
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Whos Eligible For This Procedure
Permanent implants are relatively low-energy sources, and therefore have limited tissue penetration. A well-done implant treats the prostate and the surrounding few millimeters of adjacent tissue.
The best candidates for this procedure are patients with a cancer within or near the prostate. Patients with prostate cancer thats invading nearby structures like the bladder or rectum arent appropriate for this technique.
Proton Beam Radiation Therapy
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.
Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.
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What Is This Post All About
This is a hard decisionsurgery or radiation?
Now remember, what I am going to talk about here is for prostate cancer that hasnt spreadLOCALIZED prostate cancer.
From a 30,000-foot view, surgery and radiation or both EXCELLENT treatment choices for prostate cancer. In general, you can pick and choose certain studies to support one treatment over the other but by and large they are both EQUAL in terms of cancer control.
Now remember, I am a urologist. I try my hardest to provide as unbiased as an opinion as I can but its impossible to remove the fact that I am urologist when providing this information. This is why I will always have my patients meet with a Radiation Oncologist as well as me to hear from them about what radiation is all about as I talk to them about what surgery is all about.
If you wanna learn about the ins and outs of a robotic prostatectomy then click over here. On the flip side, if you wanna learn more about the ins and outs of radiation then click here.
Conditions Treated With Proton Therapy
Proton therapy is considered the most technologically advanced radiation delivery method for cancerous tumors. With this powerful, precise technology, tumors are more accurately targeted so healthy tissues and organs get less unnecessary radiation.
Proton therapy is commonly used to treat tumors in sensitive areas where traditional X-ray or photon radiation may not be the best option. Depending on your particular diagnosis, proton therapy may be a treatment option for cancers of the brain and central nervous system, breast, esophagus, head and neck, liver, lung, lymphatic system, eyes, pancreas, prostate, bone and others. It is particularly beneficial for many pediatric cancers.
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Treatment Options For Prostate Cancer
Early-stage prostate cancer is often slow-growing. Here, it is hard to balance treatment benefits against its side effects. Therefore, delaying treatment until there is evidence of cancer progression is one way to avoid unnecessary side effects.
In some cases, a doctor may recommend watchful waiting or active surveillance to avoid unnecessary treatments.
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 some 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.
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Prostate Cancer: Should I Have Radiation Or Surgery For
Radiation therapy is more likely to cause bowel problems, 112 experienced disease progression, and radiation oncologists feel the same way about Prostate Cancer Survival Better With Surgery vs, When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery, in case of prostate cancer, and from what this study is showing, Bowel function was better after surgery than after radiotherapy the difference was statistically but not clinically significant.Prostate Cancer TreatmentThat stage comes with surgery, Prostate cancer that has grown beyond the prostate is called advanced prostate cancer, which was higher than in the surgery and radiation groups .< img src=https://i0.wp.com/grandroundsinurology.com/wp-content/uploads/2017/02/nvfdcamy0wy.jpg alt=Debate: Effectiveness of Surgery vs, the idea of getting the cancer out brings a sense of relief.
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What Are The Side Effects
Urinary symptoms are the most common side effects of the procedure. These symptoms include frequent urination and a need to get to the bathroom quickly. There might also be burning with urination and, in a few cases, an inability to empty the bladder completely. These symptoms can usually be managed with medicine, and improve over time. Temporary self-catheterization might be necessary to help drain the bladder if it cant be emptied adequately, but only about 5% of patients require it.
Urinary incontinence is rare in general. The risk might be somewhat increased in patients who have undergone a previous surgical procedure to remove a part of the prostate called a transurethral resection of the prostate . This risk can be minimized by performing a careful prostate ultrasound before the procedure to determine how much prostate tissue is still present to implant.
Rectal bleeding occurs in less than 1% of patients. Diarrhea is rare.
The impotence rate for those fully potent prior to the procedure at five years after the procedure is approximately 25% using brachytherapy alone. If hormone therapy is added, the impotence rate rises to 50%.
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