Prostate Cancer

Adenocarcinoma of the prostate is the clinical term for cancerous tumor of the prostate. Prostate cancer confined to the gland is usually curable. According to the American Cancer Society (ACS), prostate cancer is the most common type of cancer in men in the United States. The ACS estimates that about 192,280 new cases will be diagnosed in 2009 and about 27,360 men die of the disease. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. Prostate cancer occurs in 1 out of 6 men, with reports of diagnosed cases rising rapidly in recent years and mortality rates declining, likely due to increased screening.

Dr. Cornell in the operating room.Treatment for prostate cancer depends on the stage of the disease at diagnosis and the patient’s age and overall health. Elderly patients with early stage cancer or co-existing illness may be treated conservatively. The different treatment options I provide include:

Radiation Therapy

Two types of radiation therapy are used to treat prostate cancer: brachytherapy and external radiation therapy (XRT).

Brachytherapy

This treatment involves implanting tiny radioactive capsules (called “seeds”) into the cancerous prostate. The seeds emit radiation that kills cancerous tumor cells. Men with small tumors confined to the prostate (stage T1 or T2) and those with only moderate prostate enlargement are candidates for brachytherapy. The procedure is performed on an out-patient basis and takes 45-60 minutes. Brachytherapy patients usually resume routine activity within a day or so. For those who additionally have obstructive voiding symptoms, transurethral resection of the prostate (TURP) surrounding the urethra may be performed before brachytherapy is initiated.

External Radiation Treatment (XRT)

XRT is recommended as an alternative to surgery for cure of disease confined to the prostate. XRT is usually given on an outpatient basis for 6-8 weeks. High energy x-rays are projected into the prostate tissue from a machine outside the body. The radiation destroys cancer cells and shrinks the tumor.

Hormonal Therapy

Hormonal therapy for prostate cancer involves the use of medication to block production of testosterone, which prostate cancer cells use to grow. Drugs used for hormonal therapy include Lupron^®, Zoladex^®, Casodex^®, Vantas^®, Eulexin^®, and Viadur^®.

Radical Prostatectomy

Radical retropubic prostatectomy is the “gold standard” treatment for localized prostate cancer. Radical prostatectomy is the surgical removal of the prostate and surrounding tissues, including the seminal vesicles and pelvic lymph nodes.

Good candidates for prostate cancer surgery have one or more of the following characteristics:

Generally good health
Tumor confined to the prostate gland (Stage T1 or T2)
Age under 70 years
Life expectancy greater than 10 years

Radical retropubic prostatectomy involves an incision in the lower abdomen. This gives the surgeon access to the prostate, seminal vesicles, and the pelvic lymph nodes. Based on findings intraoperatively and the tumor volume anticipated from the number of positive biopsy cores done before surgery, every attempt is made to save the cavernosal nerves to the penis (nerves providing erection/potency). This maneuver adds little time or complexity to the case and can be offered by most recently trained urologists today, including myself.

Recovery

Typically, patients remain in the hospital for 2 days after surgery and are catheterized for 7 days postoperatively.

The 10 year survival rate after radical prostatectomy ranges from 75% to 97% for patients with well and moderately differentiated cancer and 60% to 86% for patients with poorly differentiated cancer.
When cancer is confined to the prostate, the disease is usually curable with erectile function and urinary control being salvaged in the vast majority of patients.

Services

Robert J. Cornell, MD, PA