Curative Treatments

If prostate cancer is confined to the prostate then curative treatments can be undertaken to eradicate the disease.

The commonly used treatments are briefly listed below.

There is no “one size fits all” treatment. Treatment options vary depending on the severity and extent of the disease, a patient's medical history and, of course, the patient's wishes.

All available treatment options should be discussed before deciding on the most appropriate one for any given individual.

 

Standard treatments

Surgery (radical prostatectomy)

This involves the removal of the entire prostate, seminal vesicles (small sacks behind the prostate) and a short part of the Vas Deferens. The latter carries sperm from the testicles, where it empties into the prostate.

The bladder is then rejoined to the urethra and the two are helped to heal together by a catheter (a tube through the penis into the bladder) left for 2 weeks or so to act as a scaffold.

The usual inpatient stay is 4-5 days.

External radiotherapy

This treatment involves the use of very high energy rays directed at the prostate gland. These rays (photons, neutrons) induce lesions in nuclear DNA. Healthy cells have a repair mechanism to compensate damage caused. This repair mechanism is less effective in cancer cells so radiotherapy can kill these defective cells. Radiotherapy does not require anaesthetic and treatment is generally given during regular visits, usually daily for 7 weeks. Hormone therapy is commonly used for several months prior to radiotherapy to shrink the prostate as much as possible.

 

Alternative options

Brachytherapy

This technique consists of implanting tiny radioactive seeds directly into the prostate gland to irradiate and destroy cancer cells. It is less suitable for patients experiencing significant symptoms from their prostate. It involves an anaesthetic and has a short in-patient stay.

Cryotherapy

In cryotherapy, the prostate is frozen under ultrasound guidance to control the extent of the freeze. The freezing kills all the tissue targeted. The procedure is done under anesthesia and requires at least an overnight stay in the hospital.

High Intensity Focused Ultrasound (Ablatherm®)

The Ablatherm® is a computer-guided medical device for the treatment of localized prostate cancer using high intensity focused ultrasound (HIFU). The energy is delivered through an endorectal probe.

The ultrasound waves travel through the rectal wall and are focused in the prostate. This focusing produces intense heat and destroys the tissue inside the targeted zone. The treatment (1 to 3 hours) can be performed under general or spinal anesthesia.