Prostate Cancer – Treatments

Treatments for localized prostate cancer

Localized prostate cancer (at stages T1 and T2) can be treated using a variety of methods, depending on the characteristics of the disease and the patient's preferences.

High Intensity Focused Ultrasound (HIFU) – A non-invasive treatment requiring no incision nor radiation

Ablatherm® HIFU treatment (or thermal ablation) destroys the prostate by "burning" it with focused ultrasound. This is achieved by inserting a probe into the patient's rectum under a spinal or general anesthetic. This probe is used both to view the prostate and to generate the high-intensity focused ultrasound pulses that will destroy it. It is possible to treat the complete prostate or a targeted area (focal treatment); it is also possible to spare the erector nerves (nerves adjoining the prostate that stimulate penile erections). The Ablatherm® HIFU treatment lasts between 90 minutes and 2 1/2 hours. It can be performed on an outpatient basis or as part of a short (1- or 2-night) hospital stay.

Radical prostatectomy – surgery

Radical (or total) prostatectomy is the surgical removal of the prostate and seminal vesicles. It is a major surgical operation performed under general anesthetic, requiring one or more incisions (cutting through the skin and underlying tissue in order to reach the organ), depending on the technique used. The patient is hospitalized for between 5 and 7 days, and there is a subsequent recovery period of approximately 3 to 4 weeks, whichever technique is used. The main side effects are impotence (i.e. an inability to achieve or maintain an erection) and incontinence (the inability to refrain from urinating).

External radiotherapy - ray treatment

The patient is subjected to high-dose rays directed at the prostate. These rays destroy the cells by causing lesions in their DNA. The treatment is divided into approximately 40 sessions over a period of 6 to 8 weeks, working on the basis of a five-day week. During each session, which lasts around 20 minutes, the patient remains immobile on the treatment table while the machine delivers the rays. The treatment is painless. The main side effects are impotence (i.e. an inability to achieve or maintain an erection), which can occur even several months after treatment, and intestinal disorders such as pain, colic and bleeding.

Curietherapy, radium therapy or brachytherapy - radioactive implants

Radium therapy, also known as curietherapy, involves temporarily or permanently implanting between 50 and 100 tiny grains of radioactive material into the affected area.These grains constantly emit rays that destroy prostate cells by causing lesions in their DNA. This procedure is performed under general anesthetic. When implanting the grains, the surgeon is guided by an ultrasound scanner (with a probe inserted into the patient's rectum). The potential side effects are essentially the same as with external radiotherapy.

 

 

Cryotherapy - cold-based treatment

Cryotherapy is a technique that freezes the prostate by inserting needles that generate temperatures below 0°C. The operation is performed under spinal or general anesthetic.

Active monitoring - monitoring without treatment

Active monitoring may be a solution for very elderly patients with symptomless, low-risk, non-aggressive prostate cancer.

With this approach, the patient has very regular (three-monthly) check-ups to track the disease's evolution and allow treatment to be arranged if and when necessary.

Treatments for advanced prostate cancer

Hormone therapy

Hormone treatments are used for patients with cancer that extends beyond the limits of the prostate. Hormone treatment does not cure the cancer, but decreases the quantity of male hormones, especially testosterone, which in turn slows the disease's progression.

Testosterone, which is produced by the testicles, stimulates the proliferation of cancerous prostate cells. The effect of hormones on prostate cancer is only temporary, and after around two years on average, patients develop a resistance to the hormones that makes the treatment ineffective.

Chemotherapy

Chemotherapy is used to treat patients who are resistant to hormones. Chemotherapy slows tumor growth and in some cases eases the pain associated with cancer.

Radiotherapy – ray treatment

In patients with metastatic cancer, radiotherapy can soothe the disease's symptoms and contain its spread.

 

 

Last update 1 June 2010.