Prostate Cancer: Treatment
After your diagnosis of non-metastatic prostate cancer, you will go through a process in which a multidisciplinary team of experts will assess your prostate cancer needs. You will be assessed by Dr. Feifer to determine the suitability for surgical treatment, active surveillance, or radiation, and will be sent to a radiation oncologist to evaluate the possibility of using various radiation techniques to treat your cancer. Also, you will be assessed for other innovative image-guided therapies such as high frequency ultrasound ablation, or trials for interstitial laser therapy (at a separate institution).
Active Surveillance: Immediate treatment may not be needed
Low-grade, and low-risk prostate cancer may not need treatment right away. Regular follow-up PSA tests, exams, MRIs, genetic tests and biopsies may be performed to monitor the progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation in a delayed fashion. Patients who opt to delay treatment for previously low-risk cancer that has progressed do as well after therapy compared to those who have opted for immediate, sometimes overly aggressive initial therapy. Active surveillance may be an option for cancer that isn’t causing symptoms, is low risk, or for someone who has a major health concern aside from prostate cancer or who is of an advanced age that makes cancer treatment not the proper choice (watchful waiting).
Surgery to remove the prostate
There are surgical procedures used to remove the prostate. The operation is called a “radical prostatectomy” and involves total removal of the prostate, some surrounding tissue and a standardized aggregate of lymph nodes in the immediate vicinity that may drain cancer cells. Removal of these nodes, which do not cause major complications, serves to help staging of the cancer, and may be therapeutic in a well selected group of males with low volume nodal spread. Surgery is often used as an option for treating organ confined cancer occasionally used to treat advanced prostate cancer in combination with other treatments.
Surgery to remove the prostate
There are surgical procedures used to remove the prostate. The operation is called a “radical prostatectomy” and involves total removal of the prostate, some surrounding tissue and a standardized aggregate of lymph nodes in the immediate vicinity that may drain cancer cells. Removal of these nodes, which do not cause major complications, serves to help staging of the cancer, and may be therapeutic in a well selected group of males with low volume nodal spread. Surgery is often used as an option for treating organ confined cancer occasionally used to treat advanced prostate cancer in combination with other treatments. To access the prostate, Dr. Feifer may use a technique that involves:
Robotic assisted Radical Prostatectomy
Robotic assisted Radical Prostatectomy: Making several small incisions in your abdomen, surgical instruments are attached to a mechanical robot which are controlled by Dr. Feifer on a console right next to the operative table. Dr. Feifer is grateful to the Trillium Health Partners foundation and all of the donors and grateful patients who made robotic surgery at THP possible.
It is important to understand that although robotic surgery is common, it is not for everyone, and discussions regarding the use of the surgical robot will occur with Dr. Feifer. Your surgical procedure will be built for you, as opposed to you being fit into an existing surgical procedure. It is the personalization of technique and plan which optimizes surgical outcomes.
Radiation therapy
Radiation is a strong option for prostate cancer, and the cure rates are excellent. It doesn’t require anesthesia, and this makes it an especially good option for older men, or for men with heart problems or other health issues that might make surgery too dangerous. Also, because it is done in an outpatient setting, most men are able to continue working right through the treatment. There are several different types of therapy, including external beam, brachytherapy, as well as stereotactic high dose radiation. Most patients are seen by Dr. Feifer also see a radiation oncologist discuss these options.
Image Guided Ablative technology
Ablative therapies, directed to their target by MRI, destroy prostate tissue with heat. Dr. Feifer performs High-intensity focused ultrasound (HIFU) treatment, which uses concentrated ultrasound energy to heat the prostate tissue and cause the tumour to die. Current research supports efficacy in well selected patients, and the quality of life benefits compared to radical surgery are self evident. For more information about Hifu, please see can-am website
Hormone therapy
Hormone therapy for prostate cancer necessarily involves medication to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone as food and removing the food causes the cancer to shrink, die or grow much slower. This form of therapy is a mainstay in patients with metastatic disease. Hormone therapy options include luteinizing hormone-releasing hormone (LHRH) as well as medications that block testosterone from reaching cancer cells, named anti-androgens. Hormone therapy is sometimes used before radiation as well.
Novel Therapies
Over the last 4 years, many novel therapies have been developed for prostate cancer, including Apalutamide, Darilutamode, Abiraterone, and Enzalutamide. The data supporting the use of these therapies in numerous disease states, from locally advanced disease to advance castrate-resistant disease, is in constant evolution. Dr. FeiferSpecializes in the delivery of these new targeted Therapies to appropriate patients.
Chemotherapy
Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy is currently used for patients with prostate cancer where the disease has spread beyond the confines of the prostate.
Targeted therapy drugs may be recommended to treat advanced or recurrent prostate cancer if hormone therapy isn’t working.
Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Your cancer cells may be tested in a laboratory to see if these drugs might help you.
TREATMENTS & CONDITIONS
Benign Prostate Gland Enlargement (BPH)
Benign prostatic hyperplasia (BPH), also called prostate gland enlargement, is a common age associated condition. An
Surgery, Medical Management of BPH
When BPH needs to be treated, the first thing that is trying is a modification of lifestyle factors. There may be food
Minimally Invasive Surgery for Advanced Cancer
Minimally invasive surgery refers to any surgical procedure that is performed through tiny incisions instead of a large opening.
Prostate Cancer
Prostate cancer is one of the most common cancers in males. When caught early, it has an excellent prognosis. Patients with advanced disease and now have an abundance
