When it comes to prostate cancer, there are a lot of choices to make. Is close observation right for you? Or do you need treatment with surgery or radiation? It all comes down to your lifestyle, health care goals, and the side effects you’re prepared to live with.
So how do you decide?
First, is your cancer confined to the prostate? At Erlanger, we use advanced MRI imaging, in addition to biopsy, to see if cancer has spread. The MRI scan can detect tumors in the prostate gland itself, as well as the lymph nodes and bones. If no cancer is detected outside of the prostate, you may be a candidate for “active surveillance.” Most prostate cancers are slow-growing and rarely cause problems. With active surveillance, you will be checked every 3–6 months to ensure the cancer does not progress. If there are signs of cancer progression, treatment with surgery or radiation will be offered. The benefit is that you could go years without cancer treatment and, consequently, without side effects from cancer treatment. Common side effects include:
- Urinary/fecal incontinence
- Blood in the stool
- Damage to nearby tissue, including the rectal or bladder walls
- Erectile dysfunction
Most side effects occur early on and may only last a few weeks — though some may require additional treatment. You are at a higher risk of side effects if you smoke or have uncontrolled diabetes.
If your cancer progresses on active surveillance, or is more advanced at diagnosis, you need to decide if surgery or radiation is right for you.
Erlanger provides a multidisciplinary approach to prostate cancer. This means that you will have a consultation with both a Urologist (surgeon) and a Radiation Oncologist. Each doctor will review treatment options so that you can make an educated decision. We want you to feel empowered, to have the information you need to make the best treatment choice for you.
Some men prefer surgery, while other men are looking for noninvasive treatment using radiation.
CyberKnife is an advanced robotic technology that delivers highly focused radiation to the prostate gland. This type of focused radiation is a specialized technique known as stereotactic body radiation therapy or “SBRT.” SBRT attacks cancer cells from multiple directions, allowing physicians to target prostate cancer precisely and minimize radiation to other organs like the bladder and rectum.
Treatment for prostate cancer with Cyberknife may last as few as five visits. Men lie on a treatment table for approximately 45 minutes while focused radiation is delivered painlessly via the robotic arm. Patients typically go back to work after treatment. Total treatment time is about a week and a half — with treatments every other day. Men love the convenience of CyberKnife and avoiding an operation.
What if you have more advanced prostate cancer? If there is cancer outside of the prostate or in the lymph nodes, it is recommended you consider external beam radiation therapy (EBRT), which uses high-energy X-rays to kill cancer cells. This option can be used in place of surgery, or after surgery if the cancer returns or not all cancer cells were removed.
Typically lasting eight weeks, EBRT delivers a low-dose of radiation daily for approximately 40 treatments to reduce potential damage to surrounding organs. Prior to treatment, special markers (fiducials) are placed into the prostate to ensure that radiation is precisely delivered throughout treatment.
Once treatment is completed, I work with my patients on transitioning to a cancer prevention lifestyle. Recommendations include:
- Get a good night’s sleep. A full 7–8 hours per night.
- Eat a well-balanced diet. 7–9 servings of fruits and vegetables daily.
- Ditch the packages. Eliminate processed foods and soda as they are full of preservatives.
- Stay active. Play with your kids, walk the dogs, take the stairs — every chance you get.
At Erlanger, our goal is to provide a team approach to fighting cancer. That’s why we not only have a multidisciplinary tumor board discussing each individual’s case among top medical, surgical, and radiation oncologists, but we also have nurse navigators, dieticians, and social workers available to help. It’s important to educate our patients on every aspect of treatment.
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