Active surveillance is a management strategy where patients are closely monitored over time with prostate-specific antigen tests, biopsies and other tests. The advantage is that patients with slow growing cancer can avoid the risks and side effects of treatment. The disadvantage is that the prostate cancer may grow or spread and be more difficult to treat. “For these reasons, we consider this strategy carefully on a case-by-case basis, making sure our patients are fully informed,” Dr. See said.
When surgery is appropriate, patients need to be aware they have options, but should carefully choose a physician who does a high volume of prostate cancer procedures. This is an important consideration in obtaining the most curative benefit with the fewest side effects. Today, where appropriate, men may choose minimally invasive, as well as open operations. Surgical options include:
Kathryn Bylow, MD
Open Prostatectomy — Open prostatectomy remains the gold standard for prostate cancer surgery. Using this approach, the surgeon combines visual and tactile information for optimal cancer control and potency preservation.
Robotic Prostatectomy —Robotic-assisted laparoscopic radical prostatectomy is a minimally invasive surgery to remove the prostate gland. The procedure is performed using the da Vinci®
Surgical System.
Cryosurgery — uses cold energy to destroy cancer cells by freezing them. Historically, cryotherapy has been used to treat the entire prostate gland. Increasingly, data shows that for select patients, focal cryotherapy (freezing just part of the prostate) can result in successful treatment with fewer side effects.
High-intensity Focused Ultrasound — with a small, transrectal ultrasound probe, ultrasound waves focus on tiny areas of the prostate, eventually treating the entire prostate. The energy creates intense heat, causing the tissue to burn, destroying cancer cells.
Another developing strategy is molecular-based risk stratification. This approach uses molecular markers to determine a patient’s risk. “In essence, it looks at the cellular machinery of those cancer cells,” Dr. See said, “to predict how likely the cancer is to grow and spread.”
The Informed Choice
Prostate cancer is often curable when it’s caught early. While that sounds simple enough, finding the best treatment for each individual patient — not just the approach with the most buzz — takes a team of prostate cancer specialists. The team at Froedtert & The Medical College of Wisconsin includes nationally recognized experts in urologic oncology, medical (drug and hormone) oncology, radiation oncology and interventional radiology — with a specific focus on urologic cancers.
Prostate and other urologic cancers are complex diseases that require several different kinds of treatment. And treating the cancer can have a significant impact on a patient’s quality of life. Our Prostate and Urologic Cancer Program offers more standard treatment options than any other medical center in the state, including organ-sparing and function-preserving treatments. And, through our active clinical trials program, patients have access to the newest treatment alternatives.
“First and foremost, we want to cure the cancer,” said William See, MD, Medical College of Wisconsin urologic oncologist and chair of Urology. “But we also want to minimize treatment-associated risks.”
Colleen Lawton, MD, Medical College of Wisconsin radiation oncologist, agreed. “We’re pursuing innovative, cutting-edge science, writing and participating in the studies. Low-risk and high-risk disease require very different approaches. That’s why you need a team of specialists who will be forthright about your options: ‘Yes, this is a very good treatment, but not for you for the following reasons.’ We emphasize giving the right treatment to the right individual for each specific situation.”
“Experience matters when it comes to treating prostate cancer,” Dr. See said. To help patients make better decisions about their care, he developed a list of questions patients should ask their providers, including:
4 Are you fellowship (specialty) trained in prostate cancer care? 4 What percentage of your practice is dedicated to cancer? To my type of cancer? 4 How many of a proposed treatment have you personally performed? 4 What are your results for this treatment in terms of cure? In terms of side effects?
“Once you make a decision and have treatment, there’s no going back,” Dr. See said, “so it’s important to make an informed decision — you have time. I encourage patients to seek a second opinion and be an active participant in the decision process.”
For more questions to ask your health-care provider, visit
froedtert.com/prostate. To schedule a second opinion appointment, call 866-680-0505.
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froedtert.com/cancer Clinical Cancer Center
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