Placement of radioactive seeds or use of beamed radiation or various types of surgery are among the options for treating Utah's No. 1 cancer killer, prostate cancer.
"There are lots of variations and a lot to consider," said Dr. Scott Chidester, urologist at the Intermountain Urological Institute at Intermountain Medical Center. Surgery can be an "open" procedure with a relative small incision or it can be done robotically. Radiation can be delivered as brachytherapy, with small radioactive seeds implanted in the prostate, or using intensity-modulated radiation therapy that shoots in from many directions to focus on the prostate.
And for some patients those not likely to live 10 years because of age or chronic disease the best choice may be closely monitoring the disease without actively treating it, according to Dr. Jay Bishoff, director of the institute.
Prostate cancer and treatment is the topic of Saturday's Deseret Morning News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Bishoff and Chidester will answer phoned-in questions. All calls are confidential. The number is 1-800-925-8177.
This month, the Deseret News and Intermountain are expanding the hotline to include a feature where questions can also be submitted by e-mail. Deadline for those questions, sent to Hotline@desnews.com, is 5 p.m. Saturday. Answers will be posted online at www.deseretnews.com at 12:01 a.m. Wednesday.
Physicians tend to prefer surgery for younger patients, reserving the less-aggressive radiation therapy for those who are older. But the decision is really up to the patient, Chidester said. Side effects are a consideration. Surgery can lead to erectile dysfunction and stress incontinence. Radiation is more likely to irritate the bladder and rectum. The two specialists agree that side effects are much better managed now than in the past.
It's not easy to compare the results of the two types of treatment, largely because for many years they each had a different definition of what constituted recurrence, Chidester said. If the PSA (prostate specific antigen) blood test was normal after radiation, it was a considered a cure. "We found that's not always the case. "A moderately high PSA after surgery is "a recurrence, probably."
Detected early, a low-grade cancer is cured nearly all the time with either surgery or radiation, but when it progresses it can be very painful as it metastasizes into the bones, Chidester said.
As for robotic vs. standard surgery, in experienced hands the results are roughly equivalent, he said. Robotic surgery may shorten recovery slightly, but it's also more expensive. So that, too, must be weighed in decisionmaking.
Because prostate cancer is sensitive to testosterone, hormone therapy is sometimes used. "When you take testosterone out, some cancer cells die," Bishoff said. That's an option for people who are not candidates for surgery or radiation, such as cases where the disease has already spread or a previous treatment didn't work.Bishoff says there are new therapies being explored. Cryotherapy, which uses freezing needles, shows some promise. So does high-intensity focused ultrasound. Those are both in advanced clinical trials.