1. Treatment of Localized Prostate Cancer Dr. Neil Baum New Orleans, Louisiana www.neilbaum.com

2. You have a diagnosis of prostate cancer. Elevated PSA, DRE or both Had a recent biopsy Video will review grading staging Further testing Treatment options for localized prostate cancer

3. Grading – Gleason score 1-10, higher score more aggressive is the tumor, <5 or 6 not very aggressive, more than 7 is more aggressive Is it localized-confined to the P.G. Locally advanced tumor cells spread to surrounding tissues. In metastatic cancer is at a distance from the P.G, possibly to more distant organs, bones, lymph nodes.

4. Additional tests: Bone scan. X-ray film of the entire body that highlights areas where the cancer spread the bones. such as the pelvis or lower spine. Ultrasound-look for effects of a urinary blockage on the kidneys. Computed tomography (CT) scan. This is the best way to detect the extent of the primary cancer as well as distant metastases. and can identify enlarged lymph nodes

5. Cystoscopy A thin, flexible tube equipped with a light and tiny camera on the end is inserted through the urethra in the penis to the bladder. This shows whether the cancer has spread to the urethra or bladder. Tests used to determine if the cancer is localized or spread beyond the prostate gland

6. Staging system of classifying tumors by size, location and extent of the spread, good indicator for prognosis. The cancer is assigned one of four stages, based on how far it has spread. The stages of prostate cancer are as follows: • Stage I (or A): Confined to the prostate. • Stage II (or B): tumor is larger and can be felt on digital rectal exam. cancer confined to prostate. • Stage III (or C): The cancer has invaded other tissues neighboring the prostate (seminal vesicles or other nearby tissues). • Stage IV (or D): The cancer has spread to lymph nodes, bones, or to other organs. Knowing the stage and grade of disease can help to determine how aggressively the disease needs to be treated and can also help predict the prognosis

7. Treatment No “one size fits all” treatment for prostate cancer. The choice of treatment depends on age, general medical condition, life expectancy, how fast the cancer is growing an benefits and the potential S.E. of the treatment.

8. Watchful Waiting -localized disease, low stage and grade, age of patient, life expectancy, and agree for regular monitoring of the PSA level

9. ERT high-powered X-rays to kill cancer cells. while minimizing harm to surrounding tissue. Usually 30-40 treatments mild side effects (rectal urgency, frequent urination and urinary urgency), but in most cases they disappear shortly after the treatment course is finished. Erectile dysfunction-

10. Radioactive Seed Implants-Brachy iodine or palladium implanted men with small prostate gland, tumor confined to the prostate and low PSA levels (<10) 50-100 rice-sized radioactive seeds are placed in the prostate through ultrasound-guided needles. Single treatment requires an anesthesia Side effects- Urinary problems, ED, or rectal symptoms (loose stools, discomfort).

11. Surgery - RP This consists of the surgical removal of the entire prostate. This operation is for localized disease Requires hospitalization from 1-3 days Usually go home with a catheter for a few days There is an excellent survival rate if cancer has not spread. Complications of this procedure include urinary incontinence and impotence in at least 50% of the patients

12. Robotic RP 5 pencil sized openings are made in the abdomen Hospitalized one day Home with a catheter Side effects are incontinece and ED

13. Cryotherapy inserting a probe freezing areas of cancer in the prostate. reserved for localized cancer for men who are unable to withstand surgery or radiation. Cryotherapy has several advantages over surgery and radiation therapy. There is less bleeding, earlier hospital discharge, shorter recovery times,

14. HIFU Uses HIFU through a rectal probe Requires a catheter after the procedure Less incontinence and ED than surgery Not approved by the FDA at the present time Available in Europe, Bahamas, Mexico

15. Summary Most common cancer in men If localized to the prostate, most men can be cured No one treatment is right for everyone. Need to have a thorough discussion with your doctor Refer you to my website, www.neilbaum.com Or Gov. website- http://www.cancer.gov/cancertopics/types/prostate