Prostate Cancer

Prostate cancer is usually first detected by:

  • An elevated PSA or
  • An abnormal prostate exam or
  • Other symptoms suspicious of prostate cancer.

The first step is to see a urologist in the Department of Urology for further evaluation. The urologist may require an Ultrasound guided biopsy to establish a diagnosis.

 

Treatment for prostate cancer may include:

  • Active surveillance
  • Surgery
  • Radiation therapy including brachytherapy and/or external beam radiation therapy
  • Chemotherapy
  • Hormonal therapy
  • Or, some combination of the above

The option for each individual patient depends on his stage of cancer, Gleason score, and PSA level.  The patient’s age, general health, and his perspectives about potential treatment side effects are important determining factors too.

 

Potentially, all treatments can cause significant side effects, such as:

  • Erectile Dysfunction
  • Urinary Incontinence
  • Rectal Bleeding
  • Muscle Weakness
  • Hot Flashes

The goals of treatment are often balanced with the risks of lifestyle alterations.

 

The following risk stratification is based on the National Comprehensive Cancer Network (NCCN) recommendations:

 

For "low risk" prostate cancer, treatment options include:

LOW RISK - Clinical Stage T1-T2aN0, Gleason score 2-6, PSA<10

  • Radical prostatectomy (laparoscopic, robotic assisted, or open prostatectomy).
  • Radiation therapy in the form of either brachytherapy (permanent seed implant or High Dose Rate Brachytherapy) or external beam radiation therapy.
  • Active surveillance

Your urologist will discuss these options with you. Based on your preference, he will then refer you to see appropriate specialist, as needed.

To learn more about early prostate cancer, follow this link.


For "intermediate risk" prostate cancer, treatment options may include:

INTERMEDIATE RISK - Clinical Stage T2b-T2c, Gleason score 7, PSA 10-20

  • Radical prostatectomy (laparoscopic, robotic assisted, or open prostatectomy).
  • Radiation therapy in the form of either brachytherapy (permanent seed implant or High Dose Rate Brachytherapy) and/or external beam radiation therapy.
  • Hormonal therapy may be given before radiation therapy is started, and generally continued for a total period of 6 months.

 

For "high risk" prostate cancer, treatment options may include:

HIGH RISK - Clinical Stage T3aN0, or Gleason score 8-10, PSA > 20

  • Radical prostatectomy (laparoscopic, robotic assisted, or open prostatectomy).
  • External beam radiation therapy +/- High Dose Rate Brachytherapy.
  • Hormonal therapy may be given before radiation therapy is started and continued for a period of two to three years.

Your urologist will discuss these options with you.  Based on your preference, he will then refer you to see the appropriate specialist, as needed.

 

Treatment for advanced prostate cancer is complex. 

  • It normally starts out with hormonal therapy.
  • Chemotherapy might be considered for patient with hormone refractory prostate cancer (prostate cancer that no longer responds to hormonal therapy).

When this is considered you might be referred to department of medical oncology for a consultation.

 

Department Contact List

 

Clinical trials available for treatment of prostate cancer at Kaiser Permanente Santa Clara:

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Comprehensive Cancer Care