Treatments Available
Active surveillance
Active surveillance is a type of close follow-up for men with prostate cancer. This follow-up usually involves regular prostate-specific antigen (PSA) tests, digital rectal examinations (DREs) and possible prostate biopsies.
How is it done?
  • Rectal exam and PSA test every 3-6 months
  • Prostate Biopsy once a year, wherein the doctor will remove 12 tissue samples from the prostate for analysis

Pros:
  • Usually a good choice for those who expect to live less then 10yrs. and/or patients with slow-growing prostate cancer
  • No downtime except for visits for the tests
  • Avoid possible side-effects of surgery, radiation or other treatment
  • If treatment is needed in the future, medical advances may make treatment more appealing/ tolerable

Cons:
  • More likely to die within 10 years from prostate cancer compared to those treated with surgery
  • Close monitoring is required; regular biopsies can increase chances of erectile dysfunction
  • If treatment is required in future, you may be at an age when it's more difficult to tolerate surgery
  • More than 40% of prostate cancer can be undergraded (considered slow- growing when it is actually fast-growing)

1. Definitive Therapies

Radiation therapy:
  • Exposes cancer cells to high doses of radiation with the goal of killing the tumor
  • External beam radiation treats the prostate and other selected tissues with a carefully targeted beam of radiation administered from a machine outside the body
  • With brachytherapy, tiny radioactive seeds are implanted in the prostate through a surgical procedure
    • Allows the radioactive seeds to be implanted into the tumor very precisely
    • Allows a higher dose of radiation to be used with potentially less damage to surrounding tissue
  • Physicians may choose to combine other treatment options, such as hormonal therapy, with radiation therapy

Pros:
  • Non-invasive therapy
  • Patient admission is not required (OPD basis treatment)
  • Minimal sexual side-effects

Cons:
  • Potential side effects include: incontinence, skin reaction in the treated area, frequent and painful urination, diarrhea, impotence, rectal irritation or bleeding
  • Long treatment duration

2. Palliative Therapies

Hormone Therapy:
  • It is used to slow the spread of cancerous cells and alleviate the symptoms associated with advanced prostate cancer
  • Principle: Suppression of testosterone which is a stimulus for growth of prostate cancer
  • Methods:

– Surgical
  • Orchiectomy- Surgical removal of testes. Outpatient procedure. Cost effective if ADT for 6 months or more

- Non-Surgical
  • Testosterone lowering therapies
    - GnRH agonists (e.g., Leuprolide and tryptorelin) which are expensive & may initially result in an increase in testosterone
    - GnRH antagonist (e.g.Abarelix, Degarelix): Similar cost issues without an increase in testosterone
  • 1 Monthly, 3 monthly, 6 monthly injections

Chemotherapy:
  • Targets and destroys rapidly dividing cancer cells
    • Unfortunately, chemotherapy also destroys normal cells that divide rapidly, such as blood cells forming in the bone marrow, hair follicles, and cells in the intestines and mouth
    • The destruction of normal cells causes side effects such as fatigue, hair loss, nausea and vomiting, diarrhea, mouth sores, and a low white blood cell coun
  • Supportive medication may be given to help offset the side effects caused by chemotherapy drugs

3. Investigational Procedures

HIFU:
  • Treats localized prostate cancer by ultrasonic ablation
  • A trans rectal probe is used to focus the ultrasound waves on the cancerous part of the prostate
  • Some complications can result from the procedure, including :
    • Impotence
    • Incontinence
    • Penile numbness
    • Urinary bladder obstruction
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