Department of Urologic Surgery
Treatment Options
Prostate Cancer Treatment Options
Our broadly based prostate cancer program includes specialists in Urologic Surgery, Medical Oncology, Radiation Oncology, Cancer Genetics and Prevention, and basic research. This comprehensive approach allows selection of the best management approach for each individual. V anderbilt has one of the largest volume experiences in the country in the treatment of prostate cancer. Amongst the options a man must consider are:
Active surveillance
Not all men diagnosed with prostate cancer need treatment and careful followup without any initial therapy is appropriate for some. Multiple factors must be considered in arriving at a decision for surveillance alone, most prominently including the desire and expectation of the individual. Our physicians recognize the role of active surveillance for some patients and can help counsel men on whether this would be the best option for them.
Radical Prostatectomy
Studies have shown that surgical removal of the prostate improves survival in properly selected men compared to surveillance alone or to other treatments. Surgery is not for everyone but it is the most commonly used treatment for cancer apparently localized to the prostate. Over 900 men will undergo radical prostatectomy at Vanderbilt in 2009.
Radical prostatectomy includes removal of the entire prostate, seminal vesicles, and, in some men, the pelvic lymph nodes. In the hands of experienced surgeons, this operation can be performed with minimal damage to adjacent nerves and muscles to decrease the risks and side effects. Over the years Vanderbilt has been one of the leaders in the country in performing radical prostatectomy through an open surgical incision (radical retropubic prostatectomy). Beginning in 2003, though, we increasingly have used a minimally invasive approach by performing robotic assisted laparoscopic prostatectomy using the DaVinci robot. We were one of the first hospitals in the country to perform robotic prostatectomy. Our experience with over 3,000 of those procedures is amongst the top few hospitals in the country. For more on robotic prostatectomy, click here.
Radiation therapy
Radiation can be effectively delivered to the prostate by Intensity Modulated Radiation Therapy (IMRT), brachytherapy (radioactive seed implantation), or proton beam therapy. Each has some advantages and disadvantages and no one radiation method has been proven to be superior to others in treating the cancer.
Cryotherapy
Freezing of the prostate can kill cancer cells and is an alternative treatment for some men. Vanderbilt has an active program in prostate cryotherapy.
High Intensity Focused Ultrasound
HIFU is a new FDA approved experimental prostate cancer treatment. It is only available in this country to men participating in a clinical study and results of its effectiveness are not known at this time.
Cyberknife
Cyberknife is a technology available through Vanderbilt which is a method of radiation delivered by precise technology. Only minimal information is currently available about its effectiveness and side effects in treating prostate cancer.
Hormonal therapy
Drugs which suppress the male hormone testosterone are used either alone or in combination with other treatments, usually to treat more advanced cancers.
Chemotherapy
Chemotherapy which shows effectiveness in prostate cancer has been developed. It typically is used for advanced prostate cancer but is being investigated for earlier use in studies of men with aggressive cancers.
Clinical protocols
Through the Vanderbilt Ingram Cancer Center, the Department of Urologic Surgery has multiple ongoing clinical trials. These explore the spectrum from strategies for prevention, new methods for diagnosis, innovative therapeutic approaches for localized disease and novel treatment of advanced cancers including chemotherapy, vaccines, and immunotherapy.
Research
The Vanderbilt Prostate Cancer Research Center includes world class scientists involved in cutting edge research to develop new treatment strategies. The focus in on translational research, i.e. discoveries which can be applied directly to patient care. We have an active clinical trials division to allow our patients direct and immediate access to innovative treatment strategies.
The different types of prostate cancer treatments are also described in the recently released Prostate Cancer Treatment Guidelines for Patients. These guidelines were produced by the American Cancer Society and the National Comprehensive Cancer Network (NCCN). The guidelines are also available by calling the NCCN at 888-909-NCNN.
