Cancer is complex — there is no routine prostate cancer, nor is there ever a routine way to treat it.
Physicians at the OSUCCC – James are nationally and internationally renowned in research and patient care for one particular cancer, and because of that expertise and understanding of cancer’s complexities and how it acts and reacts differently in each person, the very best outcomes — and the most effective means of treating cancer patients — come from a team approach.
At the OSUCCC – James, prostate cancer patients have a team of experts, which includes medical oncologists, surgical oncologists, radiation oncologists and more. Also on that team are prostate cancer researchers who help sequence tumors to identify key molecules that fuel each patient’s cancer and who then develop drugs that target only those particular molecules.
One of only a few cancer centers in the country to be funded by the National Cancer Institute to conduct phase 1 and phase 2 clinical trials, the OSUCCC – James offers patients even more of the latest, most targeted, most effective treatment options — many that are available nowhere else but at the OSUCCC – James.
OSUCCC – James Prostate Cancer Treatments
Prostate cancer grows very slowly. For some men, treatment may not be needed right away. Because men can live with the disease for years, doctors may suggest a period of what is called watchful waiting or active surveillance.
Watchful waiting involves your doctor’s decision to observe the disease and the development of any symptoms without beginning a specific course of treatment.
Active surveillance is when the doctor gives regularly scheduled exams to the patient including PSA tests, transrectal ultrasounds and digital rectal exams. If the cancer progresses, treatment may be given at that time.
The following treatments are available to treat prostate cancer:
Surgery is often the preferred method to cure prostate cancer especially if the cancer has not spread outside the gland and the patient is in good health.
Different types of surgeries may be chosen, depending on the type and stage of cancer. These include the following:
A procedure in which the surgeon removes lymph nodes in the pelvis. A specially trained pathologist analyzes the tissue for cancer cells. If lymph nodes contain cancer, the doctors may proceed with a radical prostatectomy.
A type of surgery that removes the entire prostate gland and surrounding tissues including the seminal vesicles.
There are several ways a prostatectomy is performed. These include the following:
A procedure in which the surgeon removes the prostate through the abdominal wall. Nearby lymph nodes may be taken at this time.
A procedure in which the surgeon removes the prostate through the perineum — the area between the scrotum and anus. If lymph nodes need to be removed, they are usually removed through a separate area in the abdomen.
Robotic-Assisted Laparoscopic Radical Prostatectomy
A minimally invasive procedure that uses robotic-assisted technology to remove the cancer. This type of surgery uses smaller incisions and can spare key nerves surrounding the prostate involved in bladder control and potency. Many patients experience less bleeding, less pain and faster recovery times.
Transurethral Resection of the Prostate
A procedure in which tissue is removed using a specially designed tool inserted through the urethra. This procedure is often used to treat benign prostatic hypertrophy or to relieve symptoms from the presence of a tumor before any other treatment. This surgery also may be used for patients who are not eligible for a radical prostatectomy.
Surgery for prostate cancer can pose some risks, particularly if the tumor is large or close to nerves controlling potency or erections. Some of the risk and side effects after prostate surgery can include:
- Incontinence, which is the leakage of urine from the bladder
- Shortening of the penis
- Inguinal hernia, which happens when fat or part of the small intestine bulges through weak muscles in the groin
Radiation therapy uses X-rays to destroy cancer cells and is often chosen to treat prostate cancer if the disease has not spread beyond the prostate gland.
One kind of radiation therapy is called brachytherapy (also called implant radiation therapy, internal radiation therapy and radiation brachytherapy), in which radioactive material is sealed in seeds, wires, needles or catheters and is placed directly into or near the tumor. Radiation is then precisely directed to what has been placed near the tumor.
At the OSUCCC – James, our prostate cancer experts use MRI image-guided brachytherapy, and beginning in 2015, use Calypso 4D image-guided external beam radiation, a subspecialized treatment for eligible prostate cancer patients.
The OSUCCC – James is one of only a few centers in central Ohio to house comprehensive and dedicated brachytherapy suites and also the only central Ohio facility to offer Gamma Knife radiosurgery.
It’s important to note that radiation therapy can create an increased risk of bladder and gastrointestinal cancer, urinary problems and impotence. That’s why choosing a highly experienced treatment team who can help you weigh the benefits and risks of this type of therapy is critical.
Other advanced treatment options the OSUCCC – James offers for prostate cancer include:
Hormones are produced by glands in the body and circulated in the bloodstream. They have different effects on the body. Certain male sex hormones such as androgens (which includes testosterone) can cause prostate cancer to grow. Hormone therapy stops or blocks the action of androgen hormones that fuel prostate cancer. Hormone therapy alone will not cure prostate cancer and may become less effective over time.
When this happens, surgery, certain drugs or even other hormones may help lower androgen levels or stop them from working, which can slow or stop the growth of prostate cancer.
Other hormone-based treatments include the following:
Surgical Castration (Orchiectomy)
A type of surgery in which one or both testicles are removed. This decreases the amount of hormones such as testosterone and other androgens made by the body, and this helps decrease the overall amount of hormones and stops the cancer from growing.
Luteinizing Hormone-Releasing Hormone Agonists (or Analogs)
These drugs stop the testicles from making androgens:
These drugs are often used in combination with other drug therapies and serve to block the action of androgens. Some antiandrogen drugs work on the adrenal glands, another source of androgens in the body.
A type of hormone therapy that prevents the testicles from making testosterone. This treatment may have significant physiological side effects that should be discussed in detail with your treatment team.
There may be side effects of hormone therapy including hot flashes, impaired sexual function, lowered libido and weakened bones. Your prostate cancer treatment team can help you weigh the risks and benefits of hormone therapy.
Chemotherapy uses specialized drugs to stop the growth of cancer cells, either by destroying the cells or by preventing them from making new cells. The method by which chemotherapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is often used when the cancer has spread beyond the prostate and when hormone therapy is not working or has stopped working.
Immunotherapy, also known as biologic therapy, is a treatment that uses a patient’s immune system to fight cancer. Substances made by the body, or made in a laboratory, are used to stimulate the body’s immune system to attack prostate cancer cells.
For cancer that has spread and does not respond to hormone therapy, a cancer vaccine is available named Sipuleucel-T (Provenge®). This vaccine was recently approved by the Food and Drug Administration (FDA) to treat prostate cancer.
The vaccine relies on a patient’s own immune system. Through a series of extractions and infusions of cells and plasma, the patient receives doses of their own cells that have been exposed to prostate cancer cells. This helps the body’s own cells attack the prostate cancer. The vaccine does not stop the cancer from growing but it can extend life.
Cryosurgery, also called cryotherapy, uses an instrument to freeze and destroy prostate cancer cells. Ultrasound is used to find the area that will be treated. This type of treatment can cause impotence and leakage of urine from the bladder or stool from the rectum.
If prostate cancer grows outside of the prostate gland it often moves to the bones. Cancer in the bones can be painful and lead to other problems, so doctors will try to prevent or slow the spread of prostate cancer to the bones. If the cancer has already reached the bones, doctors may control or relieve pain and any other complications as part of the treatment plan.
Certain drugs known as bisphosphonates can lower the amount of disease in the bone and reduce the risk of bone fractures.
Other treatments for bone pain caused by metastases or hormone therapies may include:
- Pain medicine
- Radiation therapy
- The radioisotope Strontium-89
- Targeted therapy such as denosumab
(Source: National Cancer Institute)
Prostate Cancer Research & Clinical Trials
For cancer patients, clinical trials mean hope. Hope for a cancer-free world and in better, more targeted ways to prevent, detect, treat and cure individual cancers.
The OSUCCC – James has more than 500 open clinical trials at any given time, with some of the world’s latest discoveries available to clinical trial patients right here in Columbus, Ohio. In fact, patients have access to more of this nation’s leading-edge, targeted treatments and drugs than at most hospitals in America.
OSUCCC – James is one of only a few U.S. cancer centers funded by the National Cancer Institute to conduct phase 1 and phase 2 clinical trials on novel anticancer drugs. These trials go only to centers that demonstrate an exemplary capacity for research and clinical care, the expertise to deliver the latest in treatments, and the infrastructure to interpret and track treatment results.
Additionally, Ohio State has nearly 300 cancer researchers dedicated to understanding what makes each patient’s cancer grow, move, metastasize or reoccur. Because of the OSUCCC – James’ NCI Phase 1 and 2 approvals, these experts can move research discoveries into clinical trials and make them available to patients sooner.
In fact, one such discovery is a soy tomato juice currently in clinical trials now for prostate cancer patients. OSUCCC – James researcher scientists across medical technology, agriculture, horticulture and food science fields at Ohio State are combining their expertise to create promising “super foods” — foods pumped up with extra naturally occurring nutrients — to use in upcoming clinical trials.
Other discoveries close to clinical trials include an all-natural, black raspberry confection that capitalizes on something called bioactives — built-in cancer-fighting properties naturally found in some fruits and vegetables — to combat esophageal and oral cancers and a high-fiber soy bread that targets colon cancer.
Who Should Participate in a Clinical Trial?
For some patients, taking part in a clinical trial may be the best treatment choice. Patients can enter clinical trials before, during or after starting their cancer treatment.
OSUCCC – James is one of only a few institutions funded by the National Cancer Institute (NCI) to conduct phase I and II clinical trials on NCI–sponsored anticancer drugs.
If you’ve been diagnosed with prostate cancer, would like a second opinion or would like to speak with a prostate cancer specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.