Prostate Cancer Treatment

Prostate Cancer: Types & Stages

90 percent of prostate cancers are the slow-growing type that can be discovered and treated early and, in most cases, cured. Our radiation oncology team will develop an effective, risk-limiting prostate cancer treatment plan based on the type and stages of your cancer. North Cascade Cancer Center is a state-of-the-art cancer treatment center with unparalleled experience, the most advanced technology, and a proven track record for best outcomes.

Stages of Prostate Cancer

It is always important to establish the exact state of the prostate cancer so your radiation oncologist can best compile a treatment plan and prognosis. The stages of prostate cancer, like other cancers, correspond with the methodology TNM – tumor, node, metastasis.

1. Tumor – The larger the primary tumor or abnormal growth, the more serious.
2. Node – The more lymph nodes that have cancerous cells, the more serious the cancer.
3. Metastasis – Serious stages involve the spreading of cancer to other parts of the body.

The extent of cancer is grouped together to establish an overall stage. The stages of prostate cancer are:

• Stage I – This is a non-invasive cancer found only in the prostate when the disease is so small it can’t be detected with a digital rectal exam (DRE) and isn’t seen in imaging. The tumor is smaller than one-half of one lobe of the prostate. Your PSA is less than 10.
• Stage II – The tumor is still restricted to inside the prostate, but has grown some.
• Stage IIa – The tumor encompasses between one-half of one lobe and two lobes.
• Stage IIb – The tumor encompasses both lobes of the prostate.
• Stage III – In Stage III, the cancer has spread outside the prostate to nearby tissues. 
• Stage IV – In this stage, the cancer has metastasized outside the pelvis.

How Will Your Prostate Cancer Be Diagnosed?

Early detection of prostate cancer gives you a much better chance of full recovery. In fact, when the slow-moving type of cancer is localized in the prostate, almost 100% of men will live at least five years. Prostate cancer screening is the key to catching cancer before it spreads. Prostate cancer screening should begin at age 40. Screening typically includes the following:

• Blood Test. Your doctor’s office technician may draw blood during your regular checkup and test for the protein PSA (Prostate Specific Antigen). An elevated PSA could indicate the presence of prostate cancer. Not all elevated PSA levels, however, are due to cancer. Inflammation, also known as prostatitis, can cause an elevation in PSA levels.
• Physical Exam. Your doctor may also perform a DRE (digital rectal exam) to check for any abnormalities in the gland. 

If your doctor is concerned you might have prostate cancer, you will be referred to a urologist for further evaluation. To determine if prostate cancer is present, your urologist will perform transrectal ultrasound-guided prostate biopsies. This is a relatively short procedure, often done in the urologist’s clinic, that utilizes ultrasound as guidance to assist the urologist in obtaining tissue samples from several areas of the prostate gland.

If prostate cancer is diagnosed, your urologist might order one of the following diagnostic tests to determine the stage, or extent, of cancer:

• PET Bone Scan – If prostate cancer is spread, one of the most likely places to find it is in your bones. This type of scan goes beyond the 3D images provided by a CT scan to show what is happening in your tissue at a cellular level. For this test, you are injected with a small amount of low-level radioactive material, which settles in damaged areas of bone throughout the body. 
• CT Scan – The CT scan will combine many X-ray pictures to make a detailed cross-sectional image of your prostate and other tissue. A
• MRI Scan – Like CT scans, an MRI can show precise images of the tissue in your prostate. The difference is an MRI uses a magnetic field and pulses of radio wave energy to create images of the area of the body scanned. Your urologist often orders an MRI scan in advance of surgery to remove the prostate gland, seminal vesicles, and lymph nodes.

Types of Treatment For Prostate Cancer

Prostate cancer is 99% treatable when caught early before the cancer spreads to other parts of the body. Your oncologist may choose one or more of the following treatments, based on your stage and type of cancer.

Robotic-Assisted Laparoscopic Radical Prostatectomy (RALP): Once a diagnosis of prostate cancer is made, your urologist will present treatment options and assist you in making an informed decision. In some cases, active surveillance is the best option. Active surveillance involves regularly (2-4 times/year) monitoring PSA levels to track how active the cancer is. In many cases, especially when detected early, surgery is an excellent treatment option with excellent, proven success. Robotic-Assisted Laparoscopic Radical Prostatectomy, or RALP, is a minimally invasive approach to removing the prostate gland, seminal vesicles, and select pelvic lymph nodes. Your urologist will provide details regarding RALP.

Non-surgical treatment options: At North Cascade Cancer Center we combine unparalleled clinical experience with state-of-the-art technology to deliver radiation therapy safely and effectively. Types of radiation therapy include access to:

• External Beam Radiation Therapies, also known as Teletherapy:
  • Intensity Modulated Radiation Therapy (IMRT) –  At our center, we determine the best method of treatment given each unique situation. Our prostate cancer radiation oncologists in Anchorage have compared IMRT to standard or conventional radiation therapy. Due to the increased accuracy of IMRT, our radiation oncologists can deliver a higher dose of radiation therapy and spare the surrounding normal tissue. 
  • Volumetric Modulated Arc Therapy (VMAT) –Volumetric Modulated Arc Therapy is a more advanced form of IMRT. It is combined with Image-Guided Radiation Therapy (IGRT) to make treatment much more precise, giving higher more effective doses, in a shortened treatment time. IGRT utilizes daily imaging (typically CT scan images) immediately prior to each treatment to ensure sub-1 mm accuracy in each radiation treatment. VMAT significantly shortens the overall treatment time, typically to less than 2 minutes. At North Cascade Cancer Center, we have the most advanced radiation therapy delivery system available. 
  • 3-D Conformal Radiation Therapy (3-D CRT) for Prostate Cancer – This type of radiotherapy uses 3D images to plan treatment and to deliver a dose of radiation therapy that projects at the best angles for your tumor, avoiding surrounding healthy structures. 
• Internal Radiation Therapies, also known as Brachytherapy:
  • High Dose Rate Brachytherapy (HDR) – This extremely precise radiation therapy uses an intense source of radiation therapy delivered through temporarily-placed applicators (catheters) implanted in and around the prostate gland. It is delivered internally via a computer-controlled machine in two to ten convenient treatments. 
  • Low Dose Rate Brachytherapy (LDR) – This radiation therapy is similar to its HDR counterpart, except it differs in its treatment delivery and length of treatment. With LDR Brachytherapy, 50 to 100 radioactive ‘seeds’ are implanted permanently into the cancerous tissue and radiation therapy is then delivered to the infected area slowly over the following month or so as the cancerous cells die. Once the seeds emit the radiation therapy.