Prostate Cancer
with David Goldstein, MD
What are the specifics of these treatments?
After being diagnosed with prostate cancer, the first step is to sit down with your doctor to determine the treatment that’s best for you. “Initially we need to ensure the cancer is still localized. In other words, still only in the prostate. We do this in part by referencing a patient’s PSA (prostate-specific antigen) level and his Gleason score,” says Dr. David Goldstein, Urological Surgeon at GBMC.
The Gleason System is a measurement of how fast the tumor is likely to grow. This system is based on numbers ranging form two to ten. A score two to four means the cancer is likely to be less aggressive. Five to six is the intermediate range. A score above seven indicates it is likely to grow very aggressively.
The first form of treatment mentioned by Dr. Goldstein is radiation therapy. With high-energy rays, this therapy kills or shrinks cancer cells and decreases their ability to divide.
There are two forms of radiation therapy. The first is called external beam therapy. Dr. Goldstein explains “We send precisely a high level of radiation directly to the cancer cells. A radiation oncologist determines the appropriate strength and dose of the beam.”
Dr. Goldstein says the typical dosing schedule entails 35 treatments over eight weeks. Because some of the radiation hits other organs, there can be slight irritation of the rectum and bladder. Some patients also experience problems with erectile dysfunction.
The second form of radiation therapy is brachytherapy. “In this procedure, working together with the radiation oncologist, we pass tiny pellets of radioactive material into the prostate” says Dr. Goldstein.
Though brachytherapy does require anesthesia, most patients can go home either the same day or the next morning. Within three to four months, most of the radiation expires from the pellets. Interestingly, Dr. Goldstein says for a month or two after the procedure, the radiation can set off the radioactive detectors at the airport. Doctors give their patients a card to pass along to screeners explaining the situation.
There are also surgeries patients can choose. In a radical prostatectomy, the entire prostate gland and some tissue surrounding it are removed. Dr. Goldstein says “This involves an incision in the lower belly with the open surgical technique or a few small keyhole incisions with the laparoscopic robotic technique.”
According to Dr, Goldstein there are some less mainstream methods such as cryosurgery and thermotherapy, which are still in the research phase. Cryosurgery involves killing cancer by freezing the cells, while the thermal procedure attacks the cells with heat.
Finally, Dr. Goldstein mentioned hormone therapy. “Hormone therapy is a non-curative medication that tells the body to stop producing testosterone. Testosterone is the ‘food’, so to speak, for the prostate. The cancer shrinks up, but it never dies completely. It’s more in hibernation mode. Sometimes we use these medications in conjunction with radiation, or for more advanced (non-localized) prostate cancer.”
In summation, Dr. Goldstein says there is a slightly higher risk of recurrence with radiation, “This is why younger men in their forties and fifties lean more to surgery. However, if you have more advanced prostate cancer, surgery may not be as beneficial as radiation therapy. If you discuss your options with your doctor, you can choose the treatment that gives you the best chance of getting back to a normal life.”
