Advances in Prostate Cancer Treatment
Wednesday, December 15, 2010
A leader in providing urological services to patients throughout Central Pennsylvania, Urological Associates of Lancaster provides patients with access to the latest techniques and technologies for the treatment and management of prostate cancer.
Photo: ©Bryson Leidich and Courtesy of Urological Associates of Lancaster
“While we know we will not be able to cure every patient with prostate cancer, there are many alternatives now available to both treat and slow the progression of the disease,” says Paul Sieber, M.D., FACS, board-certified urologist at Urological Associates of Lancaster. “We provide the full spectrum of treatment options for patients who have contained and advanced prostate cancers.”
Available Alternatives
Urological Associates of Lancaster offers several advanced treatment options, including brachytherapy and robotic prostatectomy using the da Vinci Surgical System. More traditional approaches, such as active surveillance, radiation therapy, cryotherapy and open radical prostatectomy, are also available.
Brachytherapy is a novel treatment option that involves implanting radioactive seeds within the prostate gland to treat the tumor. These seeds deliver a concentrated dose of radiation directly to the cancer. Many prefer this treatment because it is performed in a minimally invasive fashion in an ambulatory setting. Unlike intensity-modulated radiation therapy, this approach does not require patients to undergo multiple radiation treatments.
Originally used by many centers in the 1970s, brachytherapy’s initial long-term outcomes were poor. However, advances in imagery have allowed for vast improvements in technique because it provides physicians with an enhanced ability to more precisely place the radioactive seeds.
“Advances in brachytherapy technique have led to a definite improvement in outcomes,” says Dr. Sieber. “For appropriate patients, this presents an excellent treatment option, as it boasts a faster recovery than other treatment modalities, can be performed as an outpatient procedure and has a 95% cure rate in patients with favorable prognoses.”
At Urological Associates of Lancaster, a team approach is taken to brachytherapy delivery. Radiation oncologists, physicists and urologists routinely assist in the procedure, which involves using ultrasound guidance and a template to insert a series of needles containing radioactive seeds through the perineum and into the prostate. The seeds are then delivered directly to the tumor site, where they provide localized radiation therapy.
Patients with early-stage cancers make the best candidates for brachytherapy; however, brachytherapy is a viable treatment modality for patients with advanced disease when combined with intensity-modulated radiation therapy.
Radical prostatectomy, as well as robotic prostatectomy using the da Vinci Surgical System, are available at Urological Associates of Lancaster. Robotic prostatectomy provides several benefits to patients, including less blood loss, pain and recovery time following surgery.
Urological Associates of Lancaster also has an androgen deprivation therapy clinic for patients experiencing complications related to this therapy. Dual energy X-ray absorptiometry (DEXA) bone density testing for men to determine if they are experiencing bone loss due to hormone deprivation therapy is recommended for all patients receiving androgen deprivation therapy. Since 85% of men tested using the DEXA bone density test are determined to have bone loss to some extent, it is vital that men have access to the necessary services to help correct this problem.
“We are the only center in the area that provides DEXA bone density scanning and offers a formal androgen deprivation therapy clinic for men who are receiving or have received treatment for prostate cancer,” says Dr. Sieber. “Bone loss in male patients who have prostate cancer is a prevalent problem that needs attention.”
Helping Patients Identify the Most Appropriate Treatment
Because Urological Associates of Lancaster offers a wide variety of treatment options, the benefits and risks of each treatment must be considered, so patients are able to choose the most appropriate option for their individual lifestyle and diagnosis.
“When I discuss treatment modalities with patients, I always look at the possible side effects and what’s involved with each treatment,” says Dr. Sieber. “All procedures have pros and cons, including temporary loss of continence and sexual function, so it is important that patients have an understanding of what is involved with each therapy. For example, intensity-modulated radiation therapy does not require the use of catheters; however, it takes a number of weeks to accomplish.”
Increasing Options Through Clinical Trials
Urological Associates of Lancaster has a comprehensive research program that is not commonly found at many private practices. Having participated in approximately 110 trials within the last decade, physicians and research staff are experienced in helping develop new techniques and technologies for the treatment of prostate cancer.
“This is a very exciting time to be involved with research for prostate cancer,” says Dr. Sieber. “We are currently on the brink of having several different compounds available for the treatment of advanced prostate cancer and are bringing several of our projects to the cusp of becoming a reality.”
Currently, Dr. Sieber and his team are participating in a number of clinical trials for advanced prostate cancer. These include a number of different oral agents for advanced prostate cancer progressing after first-line androgen deprivation therapy, both before and after traditional chemotherapy with taxotere. In addition, continuing trials are underway with denosumab — a new agent recently approved for post-menopausal osteoporosis — for bone loss in men receiving androgen deprivation therapy.
MD News October/November 2010, Central Pennsylvania
I had a postrate byop. at the hershey med center Am 64 they found cancer on two sides gleason 3+3 -6 thinking about the seeds . Dec 6 have app. cat scane what do you think am stressed?