If you or a loved one has been diagnosed with prostate cancer, it’s important to research all of your treatment options. What worked for a friend may not be right for you, and you should choose a treatment that will provide you with the best outcome and quality of life.
Most cancers are graded from stage 1 to 4 in level of severity, but prostate cancer uses a different system called the Gleason score. In the Gleason system, prostate cancer is graded using numbers from 1 to 5. Often, prostate cancer has sections with different grades, so those grades are added together to calculate the Gleason score. The highest number on the Gleason score is 10. Your Gleason score helps determine what treatment options are possible.
What Active Surveillance Means
“For many men, prostate cancer never affects their lives,” said Christopher L. Runz, DO, attending urologist at University of Maryland Shore Regional Health. “Active surveillance means we actively watch the cancer and make sure it stays low-grade, which means the cancer may potentially never spread.”
Active surveillance requires regular prostate specific antigen (PSA) screenings and MRIs, with occasional biopsies. Men who are older and have a shorter life expectancy become candidates for active surveillance when they have a Gleason score of 7 (intermediate level).
Surgical Prostate Removal
Surgical prostate removal, or prostatectomy, is an option for men with a Gleason Score of 7 or higher when the cancer has not spread beyond the prostate. Most surgeries are performed robotically using the Da Vinci surgical system.
“Robotic prostatectomy has come a long way,” Dr. Runz said, noting that now a skilled surgeon can preserve the two nerve bundles that allow men to have erectile function, which makes it a good option for younger men.
Radiation Therapy Treatment
The most common form of radiation therapy is intensity-modulated radiation therapy (IMRT), in which a beam of radiation is aimed at the prostate for a short period of time. Patients receive treatment five days a week for six weeks.
“Small doses of radiation over several weeks can eradicate most prostate cancers,” Dr. Runz said.
However, because the areas around the prostate are also exposed to radiation, the neurovascular bundles also get radiated. This can cause unpredictable erectile function, including a total loss of the ability to achieve and maintain an erection. Radiation is a good option for older men and those unable to have surgery.
Brachytherapy Treatment
Brachytherapy is an alternative type of radiation therapy offered to patients with Gleason Scores of 6 or 7.
During the procedure, small, completely dissolvable radioactive beads are implanted around the entire prostate area. This therapy targets the affected area more specifically than IMRT and other external radiation therapies, resulting in a shorter treatment time and, often, fewer side effects.
“Brachytherapy gives off radiation, and within one to four weeks, depending on what type of seed we use, treatment is done,” Dr. Runz said. “There is no need for the seeds to be removed.”
Other Treatment Options
If the cancer has a very high Gleason Score and has spread to other areas of the body, chemotherapy and immunotherapy may be suggested. Genetic testing of the cancer is also recommended, as it may be able to predict whether a Gleason Score 6 or 7 tumor will later become aggressive.
Access the Right Treatments at the Right Time
When it comes to treating prostate cancer, it is important to have access to the best expertise possible so you can receive the right treatments at the right time. The University of Maryland Cancer Network gives you the opportunity to connect with the best treatment options available.
Led by the University of Maryland Greenebaum Comprehensive Cancer Center (UMGCCC), the UM Cancer Network provides you access to nationally renowned experts, the latest treatments, and promising clinical trials close to home. When you work with a UM Cancer Network cancer center, your community hospital will work in partnership with UMGCCC to help you beat cancer.
