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Prostate Cancer Treatments & Alternatives
Traditional Treatments
 Surgery
(radical prostatectomy)
The whole prostate is removed with the seminal vesicles, the
deferent canals (which conduct the sperm), part of the bladder
neck and the surrounding lymph nodes. This surgical intervention
is invasive and involves the use of general anesthesia for 3
to 4 hours and hospitalization for a number of days. At the localized
stage (stages T-1 or T-2) a radical prostatectomy can be curative
but it usually results in impotence and can result in moderate
to severe urinary incontinence. Like any other major surgery
it can also have complications and can have a prolonged recovery
time.
 External
beam radiotherapy (EBRT)
This treatment involves the use of very high-energy rays directed
at the prostate gland using a special machine. Radiotherapy does
not require anesthesia and the treatment is usually done on an
outpatient basis. Patients are usually treated five days per
week in a cancer clinic over a period of seven or eight weeks
with each session lasting a few minutes. Complications include
marked inflammation of the bladder and/or rectum, as well as
impotence as a late complication (6 to 12 months after treatment).
Late side effects can also include soilage of stool because of
damage to the rectal sphincter. Recurrent cancer after EBRT is
not uncommon and is very difficult to treat.
Therapeutic Alternatives
Ablatherm® HIFU: Transrectal High Intensity Focused
Ultrasound
 Ablatherm® is
a medical device piloted by a computer designed to treat localized
prostate cancer using high intensity focused ultrasound (HIFU).
Under a spinal or epidural anesthetic an ultrasound probe is
inserted in the rectum to map the exact outline of the prostate
gland. Using this map, high intensity ultrasound waves are delivered
through the rectal wall precisely focused on the prostate. This
focusing produces intense heat and causes the destruction of
the tissue inside the targeted zone without damaging surrounding
tissues. The treatment generally takes 1 to 3 hours.
Brachytherapy
 During
this treatment 50 - 150 small radioactive seeds are implanted
directly into the prostate gland using 20 - 40 needles. This
procedure is usually done under general anesthesia (2 to 3 hours).
It is recommended that the patient avoid close contact with children
and pregnant women for two months after seed implant. As with
EBRT, recurrent disease is not uncommon and is difficult to treat.
Brachytherapy cannot be utilized when a patient has symptoms
of prostate obstruction, when he has a Gleason stage above 6,
or when he has had a previous transurethral resection of the
prostate (TUR-P).
Cryotherapy
In cryotherapy the prostate is frozen solid. Ultrasound guidance
controls the extent of the freeze. The procedure is done under
anesthesia and requires at least an overnight stay in the hospital.
This technology has improved in recent years but is still associated
with a very high incidence of impotence and urinary incontinence.
In addition, fistulae (or holes) between the prostate and rectum
can occur, especially in patients who have had unsuccessful
EBRT. There are also a large number of patients who undergo
cryotherapy after unsuccessful EBRT who experience pelvic and/or
rectal pain.
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