Many effective treatment options are now available for prostate cancer. Determination of your best treatment plan is based on many factors, including how far the cancer has spread and how aggressive it is predicted to be; your age; other medical conditions you might have; and your attitude toward the available options. Your physician will recommend an individualized treatment plan that may include one or more of the following options: surgery, radiation therapy, hormone therapy, chemotherapy, or "watchful waiting."

Surgical Options

For many prostate cancer patients, surgery alone can offer a complete cure. John Muir Health offers the full range of advanced surgical options, including minimally invasive robotic surgery and the latest nerve-sparing techniques. The type of surgery that is best for you depend on many different factors, including the stage and the location of your cancer, your age and general health, etc. Your urologist will carefully evaluate the advantages and disadvantages of each option, and weigh the curative potential against possible side effects to determine the best approach for you.

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The full range of surgical options includes:

• Radical Prostatectomy - Radical prostatectomy is the surgical removal of the entire prostate gland, the seminal vesicles, and nearby tissue. If necessary, a pelvic lymphadenectomy may also be performed to remove adjacent lymph nodes. Prostatectomy can be performed using the traditional "open surgery" method, or one of the newer minimally invasive techniques.
• Laparoscopic Radical Prostatectomy - Some patients with early prostate cancer may be candidates for a minimally invasive surgical technique called laparoscopic radical prostatectomy. The surgeon removes the prostate through thin tubes inserted into the pelvic area via small incisions. The procedure is performed under the guidance of a miniature camera (laparoscope) which is inserted through one of the tubes and projects images onto a screen in the operating screen. The benefits of the laparoscopic approach include minimized trauma, shorter hospital stays, and decreased risk of complications.
• Robot-Assisted Radical Prostatectomy is an exciting new minimally invasive option now available at John Muir Health. Robotic surgery - using the da Vinci™ Robotic Surgical System - represents the most advanced approach to laparoscopic surgery available anywhere in the world. Surgeons operating the robotic equipment undergo extensive specialized training.
• Nerve-sparing prostatectomy - Certain patients with early-stage cancers confined to the prostate may be candidates for an advanced surgical procedure called nerve-sparing radical prostatectomy. The objective of this technique is to help preserve sexual potency by sparing the nerve bundles that control erections. During prostatectomy, the surgeon carefully cuts prostate tissue away from these bundles without damaging them. If your cancer is too extensive, nerve-sparing prostatectomy is not an option because the nerves must be sacrificed to ensure that all cancerous prostate tissue has been removed.

Radiation Therapy

Radiation therapy may be used alone, or in combination with other treatments for prostate cancer. Our state-of-the-art equipment includes five linear accelerators and two dedicated CT scanners to ensure the most precise and effective radiation therapy available.

There are two main categories of radiation therapy: external beam radiation, in which the prostate and adjacent tissues are treated from outside the body via a precisely targeted beam of radiation from special equipment called a linear accelerator; and internal radiation, in which radioactive implants are placed directly into the prostate via a surgical procedure.

Advanced radiation treatments available at John Muir Health include:

• Three-Dimensional Conformal Treatment - This sophisticated form of external beam therapy uses a computerized treatment planning system that optimizes radiation therapy by pinpointing the location of the tumor with the highest level of precision possible. Special features on the linear accelerator called multi-leaf collimators enable the radiation beam to be "shaped" to closely conform to the contours of the tumor. This permits a higher dose of radiation to be administered directly to the prostate, while diminishing the radiation dose to surrounding tissue, thereby increasing cancer-killing effectiveness while minimizing toxicity.
• Intensity-Modulated Radiation Therapy (IMRT) is a newly introduced enhancement of the technology used in three-dimensional conformal therapy. Specialized treatment planning software is used to development a precise plan that "modulates" or varies the radiation used in each treatment session. The highest possible doses of radiation can be applied directly to the prostate, while lower doses are applied to areas adjacent to organs and critical structures that need to be protected.
• Permanent Seed Implantation (PSI) - PSI is an advanced form of internal radiation treatment in which small radioactive "seeds" are implanted directly into the prostate gland. These seeds gradually deliver targeted, localized radiation over a period of months, potentially causing less damage to surrounding tissue.

Hormone Manipulation

Hormone therapy - also called androgen ablation - is sometimes used before radiation to shrink the tumor. It may also be used in patients with metastatic cancer or those who experience a relapse. Hormone therapy entails the use of drugs to block the effects of testosterone, a male sex hormone that stimulates growth of prostate cancer cells. These hormone-blocking drugs potentially can slow the spread of the tumor. In some cases, advanced prostate cancer may also be treated with chemotherapy. The newest hormone and chemotherapy agents are all available to patients at John Muir Health.

"Watchful Waiting"

For some patients with newly diagnosed prostate cancer, a period of careful observation rather than immediate treatment may be recommended. This approach - known as "watchful waiting" - may be appropriate in men over the age of 70, or when tumors are considered less aggressive. Many cancers never cause symptoms because they spread very slowly, and treatment can be postponed indefinitely. Your physician will carefully evaluate many individual factors before recommending observation as a course of action.

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