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 Prostate Cancer Treatment Options

In recent years, medical researchers have discovered more effective ways to treat prostate cancer than ever before.

That is especially true at City of Hope. As one of the world’s leading cancer treatment facilities, we have a staff of highly respected physicians trained in the most advanced techniques.

  • Robotic-assisted prostatectomy (da Vinci S Surgical System)
  • Radiation therapy, including TomoTherapy, brachytherapy and intensity-modulated radiation therapy
  • Innovative chemotherapy and clinical trials of leading-edge treatments

State-of-the-art robotic-assisted surgery
City of Hope was one of the first cancer centers in the country to adopt this amazingly precise, minimally invasive surgical technology. The procedure requires five tiny incisions. First, a pencil-thin laparoscope (a lighted tube with a video camera) is inserted, so live images can be transmitted to a computer. Through the remaining incisions, four slender robotic arms with miniature surgical instruments go to the surgical site. The surgeon sits at a nearby console, viewing the procedure while using grippers to remotely control the tiny tools.

Because the robotic arms can rotate 360 degrees, these instruments can move with a full range of motion as they cut and suture with great precision. A highly magnified real-time three-dimensional image helps the surgeon avoid delicate nerves and muscles surrounding the prostate. Less surgical trauma means less risk of side effects for our patients.

Patients who undergo robotic surgery experience less pain and recover faster. Typically, recovery from conventional surgery takes three to four days in the hospital, and up to six weeks at home. With robotic-assisted surgery, the hospital stay is reduced to one or two days. Recovery time is only two to three weeks — less than half as long as traditional surgery.

With smaller incisions, patients also experience less blood loss. This helps reduce the need for transfusions, keeps blood pressure stable, and lowers the risk of complications. Patients typically emerge from surgery stronger, and can get back to normal life sooner.  

Finally, because robotic-assisted surgery does not require a large abdominal incision, there’s less pain and less need for pain medicine. Most patients are on their feet within hours of surgery.

View a video about our robotic prostatectomy

Advanced Radiation Therapies

TomoTherapy
Combining three-dimensional imaging with intensity-modulated radiation therapy technology, TomoTherapy bombards the tumor from all directions with hundreds of pencil-thin energy beamlets. The radiation matches the contours of the tumor precisely, delivering the optimal dose while avoiding normal tissues nearby. With less unwanted exposure, TomoTherapy offers better results, reduced risk of complications and fewer side effects.

Brachytherapy
In this procedure, tiny pellets of radioactive material smaller than a grain of rice are inserted directly into the cancerous tissue. The radiation attacks the tumor from the inside out. By directly targeting cancer, brachytherapy minimizes radiation to healthy tissue. In most cases, complications are few, and recovery is relatively rapid.

Radiation Therapy Side Effects
Any radiation treatment affecting the pelvic region can cause difficulties with urination, bowel problems and sexual side effects such as erectile dysfunction. These are often temporary, and can usually be treated with medication or other strategies if necessary.

Other Treament Options

Hormonal Therapy
Male hormones called androgens help the prostate develop normally during adolescence. But as time goes on, these hormones can promote the growth and spread of prostate cancer. By lowering androgen levels in your body, those same cancers can be made to shrink, or at least grow more slowly. While not a cure, hormonal therapy can put the cancer in a kind of “hibernation” for many years.

There are three kinds of hormonal therapy:

  • Anti-androgens Drugs that block your body’s ability to use androgens, they are often used in conjunction with the two methods described below. 
  • Luteinizing hormone-releasing hormone analogues Drugs that decrease the production of androgens, they are injected either monthly or every four months, depending on which medication is used.
  • Orchiectomy This is surgery to remove the testicles, where most of the body’s androgen is produced.

Chemotherapy
Chemotherapy – the use of anticancer medicines – includes a wide range of drugs and treatment strategies to treat prostate cancer. City of Hope provides both standard chemotherapies as well as access to newly developed drugs through an extensive program of clinical trials.

As part of the treatment team, a medical oncologist will evaluate the best options, so that a course of chemotherapy, if appropriate, can be tailored to the patient.

Erectile Dysfunction and Incontinence
Erectile dysfunction and loss of bladder control are potential — most often temporary — side effects of prostate gland removal. At City of Hope, patients report a 70 percent continence rate six months after surgery. Regaining sexual potency depends on the extent of your surgery, and how functional you were before the operation. Most men find that their erections return a week to 18 months after their surgery. Medications may be used to assist with recovery.  

Many men find City of Hope’s Prostate Support Group helpful, as well as our Continence Recovery Program and assistance for potency recovery.

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Having your Robotic-assisted Prostatectomy at City of Hope brochureRead more about Having your robotic-assisted radical prostatectomy at City of Hope.
(English .pdf) (Spanish .pdf)

 Robotic Prostatectomy FAQs

Since 2003, City of Hope has been performing prostatectomy using the da Vinci® surgical system (DVP), allowing our physicians to take a giant leap forward in the treatment of prostate cancer. The robotic technique provides unparalleled surgical accuracy to significantly reduce blood loss and improve postoperative recovery.  City of Hope performs more robotic assisted prostatectomies than any other medical center in the Western U.S and is second in the nation.

With the state-of-the-art da Vinci® computer-enhanced minimally invasive surgery system, City of Hope surgeons perform the same procedure done in conventional laparoscopic prostatectomy, but are aided by a three-dimensional computer vision system to manipulate four robotic arms. A pencil-size video camera held by one of the arms is inserted through an incision to provide magnified, 3D images of the surgical site. The 3D view helps the surgeon more easily identify the delicate nerves and muscles surrounding the prostate. The robotic arms can rotate a full 360 degrees, allowing the surgeon to manipulate surgical instruments with greater precision, flexibility and range of motion.

To view informational video on robotic assisted prostatectomy click here

Patients experience significantly less pain and less blood loss than those undergoing conventional “open incision” procedures. In addition, patients tend to enjoy quicker recovery time.
A traditional, open radical prostatectomy requires two days hospitalization and recovery lasting about 2-3 months. With robotic assisted surgery the recovery time is as little as two weeks – a greater than 50 percent reduction in recovery time.

City of Hope was one of the first cancer centers in the United States to begin performing the robotic assisted laparoscopic radical prostatectomy. Since October 2003, our physicians have performed over 3100 cases, more than any other site in the Western U.S and second in the entire U.S.

The department of Urologic Oncology at City of Hope specializes in the diagnosis and treatment of prostate cancer, bladder cancer, kidney cancer, and other urologic malignancies, providing therapies for patients that not only treat the disease but also attempt to achieve the best quality of life.  Since 2000, we have been using state-of-the-art minimally invasive techniques for the treatment of urologic malignancies.  Both the institution and the department were recently named as “America’s Best Hospitals” in cancer and urology by U.S. News and World Report.   We were the first regional cancer center to implement and subsequently advance the use of standard laparoscopic techniques for the treatment of prostate and bladder cancers.  
 
In 2003, after an initial experience with over 500 laparoscopic radical prostatectomies we implemented the use of the da Vinci® surgical system into our practice.  Since then, we have become the busiest minimally invasive and surgical robotics program worldwide and have performed over 3,100 robotic prostatectomies.  In 2007, we performed approximately 721 robotic prostatectomies.
 
The robotic program at City of Hope includes robotic and oncology fellowship trained surgeons, fellows, a dedicated operating room team, nurse practitioners, physician assistants, and research coordinators.  We currently have four new generation, four-arm robotic systems, including the da Vinici S High Definition platform.  All of our procedures are performed in minimally invasive operating theatres, utilizing Karl-Storz OR1ä integrated and automated suites.
 
The operation typically takes 2 to 3 hours, and is performed under general anesthesia.  Most patients have an estimated blood loss of 300 milliliters, and therefore less than 3% of patients are expected to need a blood transfusion).  Most patients typically spend one night in the hospital, and can expect to get discharged the following afternoon if their laboratory tests are acceptable, pain is controlled with oral medications, and they are able to tolerated oral liquids.  Patients are discharged with an indwelling foley catheter which will be removed in the clinic 5-7 days after the operation.  Patients who do not reside in the local vicinity, can sometimes have their catheters removed by their community urologist.  At the first post-operative visit, we review and discuss pathology results, and potential need for any adjuvant therapies if indicated. Most patients have a convalescence period of 2-3 weeks, and can expect to return to their normal activity 4 weeks after surgery.  
 
Based on our most recent data review, our pathological positive margin rate is below 20%.  The average time to regain continence is about 40 days, with almost 96% of patients reporting continence at one year after surgery.   Patients may be enrolled in a continence rehabilitation program to strengthen their pelvic muscles and accelerate their recovery.  Furthermore, depending on age and pre-operative erectile function, approximately 70-80% of patients can expect to have return of potency with or without the use of oral medications.
Anyone diagnosed with localized prostate cancer may benefit from robotic-assisted prostatectomy. However, the decision to have prostate cancer treated surgically revolves around numerous considerations. Variables that enter into preoperative evaluation include age, pre-biopsy PSA, biopsy findings, previous prostate cancer treatments and other illnesses.  Robotic prostatectomy can be done for men of all sizes and shapes. The surgery can be done in men who have had other operations: appendectomy, laparoscopic hernia repair, repair of abdominal trauma, transurethral prostatectomy (TURP), and in some men who have been treated with previous pelvic radiation.
Yes. This surgery removes the prostate, seminal vesicles, ends of the vas deferens, and, depending on oncological considerations, nerve bundles and/or lymph nodes.
Best Of logoCity of Hope has been named one of "America's Best Hospitals" in cancer and urology by U.S.News & World Report. Read more here...
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