Prostate Cancer

prostate cancerThere are many options for treating prostate cancer. Part of what goes into the decision about prostate cancer treatment has to do with the characteristics of each individual patient’s cancer that can be measured. For example, what was the PSA at the time of the biopsy? How many samples showed cancer, and how many were taken? Did the cancer cells look aggressive? This is usually measured by what is called the Gleason score. Other tests and measures can also be pursued in select cases. The tools available in prostate cancer diagnosis, treatment and monitoring has grown quickly in recent years, and change and advances continue, making the choices for patients more complex but also more beneficial.

In some cases, aggressive treatment might NOT be undertaken, at least initially. This is called Active Surveillance, or AS. Some cancers may not be aggressive at all. But it is not possible to be 100% sure of which cancers will cause a threat to your health. By looking at the characteristics of individual cancer we can make an educated guess, but no one can predict with certainty how one patient’s prostate cancer will act. Active Surveillance is a great choice for some patients. And Active does mean Active! The surveillance is likely to include frequent PSA monitoring, repeated biopsies, and MRI studies. One reason for close surveillance is that in a significant number of cases there could be more aggressive prostate cancer cells present which was not sampled in the biopsy that diagnosed a cancer. Hopefully, the close surveillance will pick up on this before the disease advances. Genetic testing on biopsy material or more accurate but extensive follow-up biopsies called mapping biopsies or saturation biopsies can detect this.

Most men fear the potential side effects and complications of radical surgery (robotic or traditional surgery), radiation, or cryotherapy. With HIFU we can usually eradicate localized prostate cancer while avoiding the potential side effects of treatment like urinary incontinence and erectile dysfunction.

If you don’t feel Active Surveillance is appropriate for you, or if you have been in an Active Surveillance protocol but treatment is now needed, there are a number of choices. As long as your prostate cancer is localized to your prostate and has not metastasized, a procedure to cure your cancer is possible. There are 4 basic options: HIFU, radical surgery, radiation of different types, and cryoablation.


HIFU, which stand for high intensity focused ultrasound, is the focusing of sound waves to create heat at a specific point; this is called the focal point. HIFU is used to heat and destroy targeted tissue during an outpatient procedure; individually customized for each patient’s prostate cancer treatment. The ultimate treatment plan is adapted to each patient’s unique anatomy live during the actual treatment.

How does it work? Think about how a magnifying glass focuses light rays from the sun to a particular point and can burn a hole in a leaf.

HIFU works the same way; there is a transducer, which focuses sound waves to a particular point, creates heat and destroys tissue at that point; nothing outside of the focal point is damaged. Each area treated is very tiny, perhaps the size of a grain of rice, so this kind of precision means that the total treatment may include up to 2000 or more individually targeted areas of the prostate. This precision is exactly what can minimize any side effects.

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Surgical Removal of the Prostate

A radical prostatectomy is the removal of the prostate and capsule as well as surrounding lymph nodes. There are two methods: using a traditional large incision or a robotic-assisted laparoscopic removal.

Most radical prostate surgery is done with the robotic approach. Instruments (clamps, scissors and other cutting tools and suturing and stapling devices) are passed through small holes in your abdomen to cut out the prostate and surrounding structures. The advantage to the robotic approach is less blood loss, fewer days in a hospital, less pain and a faster return to normal activities.

However, no matter what method is used, radical surgery has significant risks of urine leakage and erectile dysfunction. Overall, approximately 30% of men will suffer some degree of urine leakage. This is only severe in a much smaller percentage. Depending on your age and extent of your cancer, there is also an approximate 50% chance of erectile dysfunction. These 2 life-changing side effects can dramatically impact a man’s quality of life every day.


There are many different types of radiation. These include IMRT, proton therapy, cyberknife, and radioactive seeds (brachytherapy) Radiation side effects can include damage to structures near the prostate (such as the rectum). Newly available Space-Oar implantation, however, can help minimize rectal exposure. A small amount of protective biodegradable gel is injected through the skin and sits between the prostate and rectum and resorbs soon after radiation treatment is complete.

If there is a recurrence of prostate cancer after radiation, treatment can be a challenge. Additional radiation is not an option because the maximum safe radiation dose is typically used during initial treatment. Surgical removal of the prostate after radiation will have a higher risk of complications than initial surgery. HIFU and cryoablation are other options.


Cryoablation is a minimally invasive outpatient procedure that destroys targeted tissue by freezing prostate tissue. It is possible to freeze either the entire prostate or limited areas.

Cryoablation uses argon gas to form a brief ice ball in the prostate. The internal prostate temperature is typically -40⁰ C. Once the targeted temperature is reached, prostate cells are destroyed.

An advantage of cryoablation is that incontinence rates can be lower than those seen with radical surgery. Erectile dysfunction, however, is a significant risk.