Prostate cancer is the most common cancer in men. This year, an estimated 227,000 new cases will be diagnosed in the United States. On the positive side, deaths from prostate cancer are now declining—due to early detection and better treatments.

Revolutionary New Treatments

In recent years, great strides have been made in the treatment of prostate cancer. Some of the latest technological advancements include robotic radical prostatectomy, permanent radioactive seed implantation, and intensity-modulated radiotherapy (IMRT). Those who are diagnosed with prostate cancer should discuss options with their physician to determine which treatment, or combination of therapies, is best for them.

Robotic Prostatectomy

Robotic prostatectomy is an exciting treatment option that is used to meticulously excise the prostate using miniature tools that reproduce the motions of the surgeon's hands and wrists. Urologist Brian Hopkins, M.D., who is on staff at John Muir Medical Center, Concord Campus and John Muir Medical Center, Walnut Creek Campus, compares the visual experience in using John Muir Health's da Vinci surgical robot to "being inside the patient, with each structure greatly enlarged."

"The major advantages over traditional prostatectomy are minor trauma to the body, minimal blood loss, and rapid recovery," Dr. Hopkins explains. "Robotic surgery's precision can also potentially better preserve potency. The miniature instruments require less stretching and moving of tissues than other surgery modes, thus causing little or no harm to delicate adjacent structures. Patients are usually able to go home after the first or second post operative day and return to work or leisure activities very rapidly. Incontinence is rarely a problem, and because of finer suturing, catheter removal generally takes place in less than a week."

Most individuals who are candidates for open radical prostatectomy are also candidates for the robotic surgery. In the future, even more patients are expected to qualify for this surgery because it is a lower-risk procedure with very little blood loss.

Permanent Radioactive Seed Implantation

With more than a decade of follow-up, permanent seed implantation has proven to be equivalent to surgery in carefully selected patients, according to radiation oncologists Dan Chinn, M.D., and Vincent Massullo, M.D., who are on staff at John Muir Medical Center, Concord Campus and John Muir Medical Center, Walnut Creek Campus.

"Utilizing an ultrasound, we first perform a prostate volume study to determine whether the patient is a candidate for this procedure," Dr. Chinn explains. "The ultrasound also allows us to construct the 3-D image of the prostate necessary for treatment. Subsequently, a radiation oncologist and urologist insert permanent radioactive seeds (each smaller than a grain of rice) into the prostate gland while the patient is under anesthesia."

"In some patients, if the gland is excessively large, the prostate can be reduced using hormone blockade therapy prior to implantation," Dr. Massullo adds. "In delivering radiation to the prostate only, there is a smaller risk of affecting surrounding tissues. Low-dose, implanted seeds degrade within six to 12 months and pose no significant radiation dose to anyone."

In many cases, permanent prostate seed implantation precludes the need for more prolonged external beam radiation that commonly requires seven to eight weeks of daily treatments. In other cases, permanent seed implantation may be used as an adjunct therapy to external beam therapy for appropriate patients.

Intensity-Modulated Radiotherapy (IMRT)

Intensity-modulated radiotherapy (IMRT) has generated much enthusiasm since its introduction into medical practice. Using computer-assisted treatment planning with 3-D visualization, clinicians assign non-uniform intensities of radiation into "beamlets." In dividing large beams into smaller ones, physicians can use higher doses in areas where treatment is most needed while maintaining low toxicity in areas that need to be shielded.

"IMRT is a highly sophisticated technique to deliver external beam radiotherapy," explains Marjaneh Moini, M.D., a radiation oncologist on staff at John Muir Medical Center, Concord Campus and John Muir Medical Center, Walnut Creek Campus. "This results in better precision, higher tumor control and lower toxicity to normal structures. In appropriately selected patients with prostate cancer, clinical data suggest that better tumor control can be achieved with higher doses of radiation. This 'highly conformal' therapy allows us to shield normal tissue, delivering more intense radiation doses to the prostate while reducing the amount to the bladder and rectum. Higher doses are delivered where needed and lower doses are given to normal structures, resulting in fewer unwanted side effects."

As with traditional external beam radiation treatment, the patient is treated on an outpatient basis Monday through Friday for seven to eight weeks. This therapy is generally appropriate for individuals with localized prostate cancer and is available at John Muir Health.

These impressive new cancer therapies add more options to the wide array of existing treatments offered to patients with prostate cancer.

(Posted October 6, 2005)

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