David Perry, MD, board-certified radiation oncologist.
Once you have a prostate cancer diagnosis, your doctor may refer to the stage of the disease by a number. These numbers describe how large the tumor is and how far beyond the urinary system it may have spread. All of these factors will determine your treatment route. Learn more about prostate cancer staging.
While common, prostate cancer is a complex and sometimes hard-to-navigate cancer. Treatment options are varied, depend on a variety of factors (such as age, general health and preferences) and all come with both benefits and risks. It is important to discuss different treatments with your doctor and decide which approach is right for you.
Surgery is often the cornerstone of any cancer treatment plan. The goal of surgical oncology (surgery for cancer) is to remove the entire tumor, or as much of it as possible. You may have other treatments following the surgery to destroy remaining cancer cells and prevent it from returning. Sometimes, you have a treatment such as chemotherapy or radiation before your surgery, so the tumor is easier to remove.
Your surgical options will depend on the size and stage of the tumor. Surgical procedures at MedStar Franklin Square Medical Center may include:
- Pelvic lymphadenectomy: During this procedure, your surgeon removes the lymph nodes in your pelvis. If the lymph nodes are cancerous, surgery will not be used and your doctor will recommend a different course of treatment.
- Radical prostatectomy: This is a procedure to remove your entire prostate. MedStar Health offers a minimally invasive surgical procedure called robot-assisted laparoscopic radical prostatectomy.
- Transurethral resection of the prostate (TURP): During this procedure, your surgeon removes tissue from your prostate. This can often help relieve symptoms caused by the cancer.
Surgery to treat prostate cancer may result in impotence and leaking urine or stool. Talk to your doctor about nerve-sparing surgery, which spares the nerves that control erectile function. Depending on the size and location of your tumor, this may be an option for you.
Cancer specialists at MedStar Health may use medicines to adjust the levels of testosterone. This is called hormonal therapy. Since prostate tumors require testosterone in order to grow, reducing the testosterone level often works very well in preventing further growth and spread of the cancer. Hormone manipulation may also be done by surgically removing the testes.
The drugs Lupron and Zoladex are also being used to treat advanced prostate cancer. These medicines block the production of testosterone. The procedure is often called chemical castration, because it has the same result as surgical removal of the testes. However, it is reversible, unlike surgery. The drugs must be given by injection, usually every 3 months. Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, and erectile dysfunction (impotence).
Other medications used for hormonal therapy include androgen-blocking agents (such as bicalutamide), which prevent testosterone from attaching to prostate cells. Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.
Radioactive Seed Implantation
MedStar Health cancer specialists use prostate seed implementation to treat prostate cancer. It is a form of brachytherapy, a mode of treatment in which radioactive material is implanted directly into the organ containing the tumor.
Prostate seeds are tiny titanium metal capsules about the thickness of a toothpick. They contain either radioactive iodine (I-125) or Palladium (Pd-103). Each seed produces a high level of radiation, but only to an area about the size of marble. Seeds are implanted in the prostate through thin tubes, and when the tubes are retracted, the radioactive seeds become permanent implants.
This minimally invasive procedure is popular among men with prostate cancer. It is performed in the operating room under general anesthesia, and the radiation oncologist uses computer software programs, CT scans, and transrectal ultrasound to determine the total amount of radioactivity, as well as the number of seeds and seed distribution required within the prostate.
External Beam Radiation Therapy
Your team of specialists will likely recommend one of the following radiation treatments for prostate cancer:
- Intensity-Modulated Radiation Therapy (IMRT) uses devices that allow the radiation beams to move and change intensity, depending on what kind of tissue they are targeting. This flexibility allows different areas of a tumor to receive different amounts of radiation and protect surrounding healthy tissue from unnecessary radiation exposure.
- Image-Guided Radiation Therapy (IGRT) uses high-quality imaging technology to create images of the targeted tumor during the radiation procedure. Using these images, your radiation oncology team carefully adjusts the radiation beams during your treatment session to best fit the size, shape, and location of the tumor while sparing normal tissues. This technology delivers high doses of radiation to the prostate gland for cancer cure and reduces the dose to normal structures such as the bladder and rectum to lower the risk of side effects.
- CyberKnife Radiation: CyberKnife technology allows for the treatment of prostate cancer over just five days, instead of 44. This is possible due to highly precise radiation delivery which allows for dose escalation. Treatment accuracy is of the utmost importance, the prostate is a moving target—it moves when urine fills and then empties from the bladder and when air moves into the rectum. CyberKnife, with an advanced combination of computer and imaging technology, identifies the exact location of the prostate, coordinates with the Synchrony® Tracking System (which follows the prostate's movement as you breathe), and accurately focuses radiation on the prostate while avoiding surrounding healthy tissue. Learn more about prostate cancer treatment with CyberKnife.
You will be closely followed after completing treatment to assess for treatment response. This involves routine doctor's checkups and blood work.
For a physician referral, please call 443-777-7900.
For more information about our clinical trials, please call 443-777-7364.
MedStar Franklin Square Medical Center
The Harry and Jeanette Weinberg Cancer Institute
9103 Franklin Square Drive
Baltimore, MD 21237