Prostate cancer is a very common malignancy in men, identified in nearly 190,000 men in the US annually. It is important to understand that prostate cancer can be slow growing in some men and aggressive in others, and therefore can behave differently in each patient. It is a cancer that often lacks respect because for the majority of men it is a low risk malignancy that does not require treatment. Unfortunately 30,000 men die annually in the United States from prostate cancer. Further complicating the diagnosis is the current controversy regarding the benefits of PSA screening for prostate cancer because many men may be unnecessarily treated for the disease without benefit of increase in lifespan and subsequently have life long side effects.
Men should first seek an understanding of their illness and treatment option prior to making a decision regarding treatment. It is imperative for men newly diagnosed with prostate cancer to seek out the opinion of a urologist-surgeon, radiation oncologist, and medical oncologist, as well as the opinion of their primary physician so that a well balanced, consensus opinion of several experts can be considered prior to undergoing treatment. This process can take a month or longer but will serve the patient well in understanding the risk of their prostate cancer and the benefits and side effects that can accompany treatment. Additionally Lawrence Cancer Center created the PSA – “Prostate cancer Support Advocates” support group which meets on a monthly basis. This group of men includes a spectrum of patients who meet for education lectures and share their treatment decisions and experiences with those who are recently diagnosed.
Treatment options can include watchful waiting, prostatectomy, radiation therapy alone, or a combination of surgery followed by radiation, radiation with hormone therapy. For patients who choose treatment with radiation therapy, Lawrence Cancer Center offers IMRT – intensity modulated radiation therapy with daily image guidance using either cone beam- ct or kv images. The linear accelerators are state of the art, were commissioned in 2012 and 2014. Our board certified physicians have collectively treated over 1,000 patients with prostate cancer at all stages of disease. Patients should be cautious of doctors, radiation oncologist and urologist, who insist or push patients to receive care in Kansas City of other locations for “bells and whistles” or claims of “unique team expertise”. These physicians may try to create a sense of fear in patients who choose to have their treatments elsewhere. Typically these doctors have their own productivity at heart more than concerns for patients driving inconvenience and expense.
During the consultation with a radiation oncologist, you will have your pathology report reviewed and risk of cancer progression explained. You will be explained the options for treatment with an emphasis on radiation therapy. The process of treatment, probability of cure, and potential side effects will be reviewed in detail. The advantages of radiation therapy over surgery include the non-invasive treatment option with equal benefit for cure with very low risk of incontinence or impotence. While radiation therapy is daily and inconvenient, it allows patients the ability to continue to work, exercise and engage in sexual activity during the course of treatment. Frequently, patients feel enlightened with information following the consultation.
Since 2018, a new option in the treatment of low and intermediate risk prostate cancer can be delivered in five treatments. This compares with a historical treatment lasting approximately eight weeks or 40 treatment sessions. For patients with some intermediate and high risk prostate cancers, they can now be treated in 28 treatments or approximately 5 1/2 weeks.
Stereotactic body radiotherapy is the treatment of low and some intermediate prostate cancers in five sessions. It is extremely convenient and long-term studies now show that it has equal effectiveness at curing prostate cancer and equal side effects to that of traditional treatment. Men sometimes travel to Kansas City for eight weeks unaware that this extremely convenient therapy is available in Lawrence. It utilizes the placement of three small markers in the prostate and a total of five sessions lasting no more than 30 minutes per treatment.