Prostate Cancer Treatment Approaches
City of Hope is home to California's largest prostate cancer program (according to data from the Office of Statewide Health Planning and Development, OSHPD) and one of the world’s leading prostate cancer treatment facilities. Our surgeons pioneered the use of the da Vinci Surgical System in high precision robotic-assisted prostatectomy. We employ a variety of treatments that are tailored to each man’s unique cancer. Because City of Hope offers the expertise of all cancer-related specialists in one location who work collaboratively to optimize outcomes, patients receive greater continuity of care and more coordinated treatment planning.  Our advanced treatments include:
 
  • 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
 
In addition, we are actively working on new diagnostic techniques, such as merging MRI screening with digital imaging to detect prostate cancer.
 
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.
 
Robotic-Assisted Laparoscopic Radical Prostatectomy
 


Advanced Radiation Therapies

TomoTherapy
Specialists at City of Hope were the first in the western United States to offer TomoTherapy — a targeted radiation therapy that can kill cancer cells while sparing healthy tissues nearby. 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.
 
Medical Oncology

City of Hope’s Medical Oncology Prostate Cancer Program focuses on providing the most advanced, compassionate, multidisciplinary care to patients with various stages of prostate cancer while actively investigating promising new treatment strategies. Our involvement in the management of prostate cancer patients starts very early and includes all stages of disease, ranging from localized to recurrent and advanced prostate cancer.  Our multidisciplinary team includes specialists from urology and radiation oncology who meet regularly with City of Hope radiologists and pathologists to discuss challenging cases and to develop comprehensive treatment plans tailored to each individual’s unique aspects of disease.  Because psychosocial support plays an important role in patients’ well-being, we offer an Advanced Prostate Cancer Support Group to our patients.
 
OTHER TREATMENT OPTIONS

Hormonal Therapy
Male hormones called androgens help the prostate develop normally during adolescence. But as time passes, these hormones can promote the growth and spread of prostate cancer. If androgen levels in the body are lowered, those same cancers can be made to shrink or to at least grow more slowly. Though it is not a cure, hormonal therapy can put the cancer in a kind of “hibernation” for many years.
 
There are three kinds of hormonal therapy:
  1. Anti-androgens - Drugs that block the body’s ability to use androgens; they are often used in conjunction with the two methods described below
  2. 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
  3. Orchiectomy - 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 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.
 
Dealing with potential side effects

Erectile dysfunction and loss of bladder control are potential — and 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 surgery, and how functional a patient was before the operation. Most men find that their erections return a week to 18 months after 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.