TRUS and Biopsy (trans-rectal Ultrasound and biopsy of the prostate)- done to identify and localize the cancer, usually the prostate is divided into 6 areas (sextants) and the biopsies are accomplished in each of the areas.

PSA- (prostatic specific antigen)- a blood test that checks the amount of a protein made by prostate cells

Prostatic Acid Phosphatase- PAP- a blood test that looks for metastatic disease in any location.

Alkaline Phosphatase- a blood test that looks for disease in the liver or bones. If this is abnormal, a bone scan is performed.

Bone Scan- a test where a nuclear agent is injected into the vein, is absorbed by the bones and shows if prostate cancer has metastasized into the bones

MRI with endorectal coil- a scan where a balloon catheter is placed into the rectum and a scan is performed to show if the cancer has grown through the capsule of the prostate, into the adjoining seminal vesicles or into the lymph glands.

2-3 hospital days, full recovery over 4-6 weeks


a) incontinence- significant improvement in 3 –6 months, 7% severe long term incontinence; treatment- Kegels exercises, adult diapers or pads, condom catheter, penile clamp, avoid caffeine after 6 months if severe may consider the surgical placement of an artificial sphincter or a surgical sling procedure

b) blood loss requiring transfusion

c) impotence 50% if normal preop, early use of Viagra tends to improve the impotence rate, late treatment consists of vacuum devices, injection of medications into the shaft of the penis, medications placed up the urethra, or a surgical implant

d) bowel urgency generally resolves in 3 months

e) stricture or bladder neck contraction- a scar in the urinary tract

f) heart attack, stroke, blood clots, death

1-2 hospital days, faster recovery
has not been preformed as long as Radical Prostatectomy
still trying to prove that it is equal or better surgery than Rad Prostatectomy
same potential side effects as Open Radical Prostatectomy
not preformed at all institutions
if having difficulties during surgery may have to change to open Radical Prostatectomy

Seeds (low dose radiation) needles placed between the scrotum and the rectum
Iodine-125- half life 2 months, Paladium-103- half life 17 days

HDR (high dose radiation) overnight stay where needles are placed into the prostate and radiation is delivered through them on the 1st post op day and then they are removed

Side effects: frequency and urgency of the bladder and bowels,
difficulty to empty bladder, retention at 6 months-1%
oral medications post op- Flomax/Hytrin/Cardura

Impotence: if no problems pre-op- difficulty maintaining erections post op
if problems maintaining erections pre-op- impotence post op
meds given- Viagra/Levitra/Cialis
Late impotence (3-5 years)- 50%

Fullness in the perineum- use an inflatable or sponge doughnut to sit upon
heart attack, stroke, blood clots, death- rare

Usually an overnight stay
8 and 10 year data same as surgery for cure, unknown 15 year data, may be repeated if not completely successful


6-8- needles placed between the scrotum and the rectum with an ultrasound in the rectum, use Argon to freeze to –40 and Helium to heat, a warming catheter is in the urethra to maintain the urethra

Generally a foley catheter in the urethra or a suprapubic tube for 1-2 weeks
Urinary urgency and urge incontinence generally resolve in a month
Long term urinary flow and urinary symptoms are generally the same or improved postop
Bladder spasms generally resolve in 12 hours
By the 1st post op day, pain is usually mild needing Tylenol or Advil
Fullness in the perineum- use an inflatable or sponge doughnut to sit upon
Scrotal and penile edema can be severe in 25%- resolves in 2-6 weeks
Rx Jockstrap/ice
Impotence- 100%, 40% return of potency within 4 years
Heart attack, stroke, blood clots, death- rare
Recto-urinary fistula- 1%, incontinence – 1%
Urethral slough may cause cloudy urine, urinary frequency and urgency

This is done to preserve potency
Controversial because Prostate Cancer is usually a multifocal disease
We leave live prostate tissue which could either contain live, undiagnosed prostate cancer, or may develop it in the future,
Less swelling, urinary urgency, retention
For patients considering watchful waiting, focal therapy is an option

Given 5 days a week for 6 weeks
3 gold seeds are placed in the same manner as the prostate biopsy to localize the prostate
during irradiation there is a loss of energy
frequency and urgency of the bladder and bowels may be short or long term
blood in the urine and bowel movements
impotence is possible long term

Not FDA approved, treatments take place in Mexico or the Dominican Republic
Results and side effects look promising, still not well known
Prostate must be < 50 cc’s
Urethral stricture
Impotence 28-100%, partial HIFU can be done to maintain potency
Incontinence 0-23%
Fistula <0.5-7.5%
Short term urinary retention 80%
Frequency, urgency, difficulty voiding resolve in 2 months

Lupron / Goserlin – injections every 1 or 3 or 4 months or a 1 year implant
Flutamide / Casodez / Nilandron pills
Proscar


Hormone therapy given to people with metastatic disease, elderly who are not candidates for curative therapy, brachytherapt/cryotherapy/HIFU to decrease the size of the prostate to improve the ability to treat it

This is reserved for hormonally resistant tumors and for late stage disease. It is generally given by Oncologists