Intermediate Risk Prostate Cancer

Treatment for Intermediate Risk Prostate Cancer 

Intermediate risk prostate cancers are the most frequently treated prostate cancers. They are cancers that are confined to the prostate, often are Gleason 7 and have a PSA of less than 20.  These cancers are treated in men with life expectancy greater than 10 years to prevent spread of the cancer in the long-term. There are a number of different effective treatment options for intermediate risk prostate cancer and the decision is often a personal one. Here at UCLA we recommend consultation with both Urologist and Radiation Oncologist to help men decide which treatment option is best for them.  

What are the treatment options for intermediate risk prostate cancer?

Robotic Prostatectomy

Robotic prostatectomy is offered by urologists at UCLA as a treatment approach for patients with early-stage prostate cancer. It offers a minimally invasive treatment with less blood loss and a more rapid overall recovery. The robotically-assisted laparoscopic prostatectomy is performed at UCLA Urology by Karim Chamie, MD, MSHS, Arnold Chin, MD, PhD, Mark S. Litwin, MD, MPH, Robert Reiter, MD, and Chris Saigal, MD, MPH using the da Vinci robot. Our surgeons at UCLA have extensive experience in treating intermediate risk prostate cancer patients, having completed more than 3,500 robotic prostatectomies since the program began in 2003.

A robotically assisted procedure puts the advantages of minimally invasive surgery in the hands of skilled UCLA cancer surgeons who have a wealth of experience in treating prostate cancer through open surgery. These tools allow them to apply their skills in successfully treating prostate cancer in a minimally invasive procedure while sparing nerves to preserve potency and sparing continence to preserve urinary control. The robotically assisted procedure is performed using five or six keyhole incisions, and offers the advantages of reduced blood loss, reduced pain, shorter hospital stays and a significantly faster recovery. Robotic tools offer freedom of motion that is similar to that of the human hand; an improvement over the traditional laparoscopic tools. Visualization is improved with a more mobile camera system that provides a three-dimensional view.

• Same-day Robotic-assisted Prostatectomy: UCLA Urology robotic surgeons have been offering outpatient prostatectomy since 2011 for appropriate patients. Men are discharged to home the same day of surgery instead of remaining in the hospital overnight, as is customary. Same-day surgery for prostate cancer is made possible by the extremely low risk of bleeding and need for blood transfusions (<1%), as well as the low degree of pain associated with robotic surgery. Men usually return to their physician’s office the morning after surgery for a routine check and within one week to remove either a urethral or suprapubic tube that drains the bladder following surgery (so called urethral catheterless surgery). UCLA Urology surgeons also no longer use abdominal drains in appropriate patients following this surgery, reducing discomfort and bother associated with the surgery. Outpatient, or same-day, prostatectomy is particularly suited for young men without any prior health conditions.
• Lymph Node Dissection: Other surgical procedures may be performed on men with advanced or recurrent prostate cancer disease. For these men, in addition to removing the prostate gland, the lymph nodes in the area of the prostate may be removed either before or during the same operation. UCLA offers both standard lymph node removals as well as what is termed “extended lymph node dissection” for men with a high-risk of nodal involvement. This is done to determine if the prostate cancer has spread to the lymph nodes.
• Surgery Techniques for Radical Prostatectomy - Prostate Nerve-Sparing: A nerve-sparing radical prostatectomy is ultimately designed to preserve a man's sexual function. The success rate in preserving sexual potency is dependent on a few factors - a man's age, the quality of his erection prior to the surgery, and the surgeon's skill and experience in protecting and preserving the nerves during the prostate nerve-sparing operation.  
• Robotic Surgery at UCLA: The UCLA Department of Urology collaborated with the Department of Surgery to open the Center for Advanced Surgical and Interventional Technology (CASIT) in 2002. The Center promotes clinical, educational and research use of surgical robots and digital imaging in surgery and medicine. Using a robotic surgical system, urologists at UCLA are able to perform operations more precisely than ever before. The system filters the surgeon's hand tremors and allows better range of motion, which ultimately will narrow the deviation in surgical skill among surgeons and result in less discomfort and quicker recovery times for patients. Faculty members in the Department of Urology are also training other surgeons in minimally invasive surgery. CASIT website
• Post-Prostatectomy Penile Rehabilitation: Erectile dysfunction is one of the most common problems experienced by men following a prostatectomy. The Penile Rehabilitation Program at the Men’s Clinic at UCLA Health offers comprehensive treatment options for men suffering from erectile dysfunction post-prostatectomy. Learn more about Penile Rehabilitation.

Radiation Therapy for Prostate Cancer

Radiation therapy for prostate cancer involves the use of high-energy beams or radioactive seeds to eliminate tumors, provided by specialty doctors in the fields of urologic oncology and radiation oncology. Early-stage prostate cancer can often be successfully treated with a non-surgical option such as prostate radiation therapy. At UCLA, the most common types of radiation therapy offered for men with prostate cancer are brachytherapy, external beam radiation therapy, image-guided radiation therapy (IMRT), and stereotactic radiotherapy.

• Brachytherapy for Prostate Cancer: Since the early 1990s, UCLA has offered brachytherapy, in which a urologist, working in collaboration with a radiation oncologist and physicist, implants small radioactive pellets, or seeds, into the prostate under ultrasound guidance. The pellets then emit high doses of radiation exclusively to the prostate over the course of several months, minimizing prostate radiation exposure to the surrounding healthy tissues. At UCLA, which has an extensive database of brachytherapy cases, patients return for follow-up visits one month after the procedure so that their doctors can ensure through a CT scan that the radiation is being appropriately distributed. High-dose-rate (HDR) Brachytherapy can be used as the only treatment for prostate cancer or it can be used in combination with external beam radiation therapy (EBRT). When used as single treatment it is known as "HDR Monotherapy" and when given with external beam it is known as "combined HDR and EBRT". 
• External Beam Radiation Therapy for Prostate Cancer: External beam radiation therapy involves a series of daily treatments to accurately deliver radiation to the prostate. Treatment planning and delivery techniques such as intensity modulated radiation therapy (IMRT) can be utilized to control the dose of radiation to the desired treatment area in the prostate, allowing for optimal treatment while reducing the risk of exposure to the surrounding healthy tissue. Successful treatment requires coordination between the UCLA physicians, medical physicists, and therapists.
• Stereotactic Body Radiotherapy (SBRT) for Prostate Cancer: Stereotactic Body Radiotherapy (SBRT) is a non-invasive technique that uses 5 treatment sessions of highly focused radiation on a special treatment machine (the Novalis Tx ) that allows for maximal accuracy. The delivery of SBRT is accomplished with image-guidance (IGRT) via 3 implanted gold seed markers in the prostate gland. This image-guidance is integrated with an intensity modulated beam that is shaped to fit and surround the prostate gland, aiming at the prostate gland continuously as the gantry rotates around the patient. UCLA physicians were some of the first in the world to have pioneered the use of stereotactic radiosurgery techniques for prostate cancer. 

Focal Therapy for Prostate Cancer

With recent advances in MRI and targeted biopsy, we are better able to locate the exact area of prostate cancer.  Men who do not have an enlarged prostate, who have prostate cancer that is detected only in a single region of the prostate and have intermediate grade cancer can be a candidate for focal therapy. This type of therapy treats only the cancerous tissue and spares the normal prostate, thereby preserving urinary and sexual function 

Here at UCLA we commonly use cryotherapy or HIFU to focally treat prostate cancer.  Given that this is a relatively new form of treatment, we have established rigorous post-treatment protocols using MRI and biopsies to ensure that the cancer has been adequately treated.

• Cryotherapy for Prostate Cancer: Cryotherapy (also called cryosurgery or cryoablation), the use of very cold temperatures to freeze and kill prostate cancer cells, is an option for men who have local prostate cancer or who have a recurrence after radiation therapy. Cryotherapy can be performed in a focal or whole-gland manner depending on your specific cancer risk. Our expert team for cryotherapy includes Dr. Leonard Marks and Dr. Robert Reiter. 
• High-Intensity Focused Ultrasound (HIFU): High-Intensity Focused Ultrasound or HIFU is an FDA-approved, minimally invasive procedure for the treatment of prostate cancer that offers personalized treatment and dramatically reduced side effects. HIFU destroys prostate cancer through the delivery of precise and focused sound waves to a targeted spot of diseased prostate tissue. This technology uses ultrasound energy, not radiation, to destroy the targeted tissue. The Ultrasound energy, or sound waves, is transmitted through the rectal wall and focused at desired locations within the prostate identified by MRI (magnetic resonance imaging) and confirmed by ultrasound. This targeted and minimally invasive approach to treating prostate cancer leaves the healthy tissue untouched and unharmed and minimizes the chance of side effects. Our expert team for HIFU includes Dr. Leonard Marks. Learn more about HIFU