In addition to prostatectomy (removal of the prostate) and radiation therapy, a few additional treatment approaches for prostate cancer exist:

  • Watchful Waiting
  • Hormone Therapy
  • Cryosurgery

Watchful Waiting

Watchful waiting, or active surveillance, is based on the premise that some cases of localized prostate cancers may advance so slowly that they are unlikely to cause men – especially older men with a short life expectancy – any problems during their lifetimes. Some men who opt for watchful waiting have no active treatment unless symptoms appear. They are often asked to schedule regular medical checkups and to report any new symptoms to the doctor immediately.

Watchful waiting has the obvious advantage of sparing a man with clinically localized cancer, who typically has no symptoms, the pain and possible side effects of surgery or radiation. On the minus side, watchful waiting risks decreasing the chance to control disease before it spreads, or postponing treatment to an age when it may be more difficult to tolerate. Of course, treatments may also improve over time if watchful waiting is chosen. Another potential disadvantage is anxiety; some men don’t want the worry of living with an untreated cancer.

Patients should educate themselves on the risks vs. benefits of not initiating definitive treatments for prostate cancer, and discuss the option of watchful waiting with their doctor.

Hormone Therapy

Hormone therapy (androgen deprivation therapy) may be used in conjunction with other treatments or alone as a primary treatment. Hormone therapy may act to halt or slow the growth of prostate cancer, and it is often used in men with advanced disease. A variety of hormonal drugs can produce a medical castration by cutting off supplies of male hormones. Female hormones (estrogens) block the release and activity of testosterone. Antiandrogens block the activity of any androgens circulating in the blood. Still another type of hormone, taken as periodic injections, prevents the brain from signaling the testicles to produce androgens.

Hormone therapy has the potential to cause a number of side effects including impotence. Men should discuss the potential benefits and side effects of hormone therapy with their doctors.

Cryosurgery

Cryosurgery uses liquid nitrogen to freeze and kill prostate cancer cells. Guided by ultrasound, the doctor places needles in pre-selected locations in the prostate gland. The needle tracks are dilated for the thin metal cryo probes to be inserted through the skin of the perineum into the prostate. Liquid nitrogen in the cryo probes forms an ice ball that freezes the prostate cancer cells; as the cells thaw, they rupture. The procedure takes about two hours, requires anesthesia (either general or spinal), and requires one or two days in the hospital.

During cryosurgery, a warming catheter inserted through the penis protects the urethra, and incontinence is seldom a problem. However, the overlying nerve bundles usually freeze, so most men become impotent.

The appearance of prostate tissue in ultrasound images changes when it is frozen. To be sure enough prostate tissue is destroyed without too much damage to nearby tissues, the surgeon carefully watches these images during the procedure. But compared with surgery or radiation therapy, doctors know far less about the long-term effectiveness of cryosurgery. Current techniques using ultrasound guidance and precise temperature monitoring have only been available for a few years. Outcomes of long-term (10- to 15-year) follow-up must still be collected and analyzed. For this reason, most doctors do not include cryosurgery among the options they routinely consider for initial treatment of prostate cancer.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci®Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

Content provided by Intuitive Surgical. For more information on this topic, please visit www.davincisurgery.com