The evolution of prostate cancer treatment

For decades, there have been two primary treatments to cure prostate cancer — surgery or radiation. However, modern technology has allowed both to leapfrog forward dramatically, improving patient results.

This is excellent news for the one in eight men who will be diagnosed with prostate cancer during their lifetime. With nearly 300,000 new cases each year and more than 35,000 deaths, prostate cancer is one of the most common forms of cancer and the second-leading cause of cancer death in men, trailing only lung cancer.

However, Dr. Siavash Jabbari, a radiation oncologist affiliated with Sharp Memorial Hospital, points out that while prostate cancer can be a serious disease, most men who are diagnosed with it do not die from it. In some cases, rather than treatment, doctors may recommend that their patients carefully monitor the disease’s progress through a program known as active surveillance.

“At Sharp Memorial, we’ve really come to view prostate cancer treatment like a team sport,” Dr. Jabbari says. “In general, radiation and surgery are thought to offer equivalent cure rates for most patients, so it’s about laying out the benefits and potential drawbacks, then developing a personalized plan to get the outcome they want.”

Radiation treatment is often chosen by patients who wish to avoid the more invasive nature and recovery process inherent with surgery. Surgery is usually selected by those who prefer to avoid the sometimes longer process and certain side effects connected with radiation.

Hitting a moving target

During radiation treatments, a high-energy beam is aimed at the prostate to kill the cancer cells. “While it’s a treatment that has been around for nearly a half-century, the therapy we use now is light-years ahead of what doctors used back then,” Dr. Jabbari says.

Radiation protocols were traditionally determined based on the limited information available at the time. Now, advanced imaging and genomic testing have unlocked a wealth of new data that allows doctors to further customize the radiation program to their patient’s tumor.

Advanced imaging, as well as the use of advanced computerized radiation planning and treatment delivery, have also dramatically improved the accuracy and precision of the beam. This was a critical advancement because the prostate can move inside the body as the neighboring bladder and rectum fill.

“The beam is focused directly at the cancer cells, so if the prostate slides just a few millimeters, you may miss that moving target,” says Dr. Jabbari. “The technology at Sharp Memorial allows us to make adjustments and help prevent radiation exposure to other organs.”

A better surgery

In the early days of prostate cancer surgery, the entire prostate was removed through a large incision. This led to a significant loss of blood and risk of complications.

Dr. David Hatcher, a urologist affiliated with Sharp Memorial, says the big breakthrough came within the last 20 years with the development of robotic-assisted surgery. The vast majority of prostate cancer surgeries are now conducted with robotic assistance. The procedures are easier on patients, with less pain and quicker recoveries.

Sharp Memorial is a leader in the use of this advanced technology and one of the first hospitals in the world to debut the da Vinci 5 robot, the latest iteration from Intuitive. The California-based biotech company has become synonymous with robotic surgical devices.

“It’s something that gets me excited to wake up each morning, knowing I get to use the newest technology,” says Dr. Hatcher. “It gives my patients great confidence in us, knowing that we’re at the forefront of medical technology.”

The next big breakthrough

Both Dr. Jabbari and Dr. Hatcher are excited to see how prostate cancer treatment will develop in the future. Beyond refining and improving the technologies that have already revolutionized care, they believe artificial intelligence (AI) could play a role in the next generation of breakthroughs.

“Advanced imaging and computing have already made a big difference,” says Dr. Jabbari. “But AI may be able to help better identify the structures within the body to tell exactly what is cancer and what is not, so we can better target our treatments.”

Dr. Hatcher adds that future technologies could further minimize the impact of surgery and allow doctors to know for certain whether all the cancer has been successfully eradicated.

But while those remain hopes for the future, he says the developments of the last few years are already game-changing.

“Patients can return to their normal activities quicker than they used to. These improvements have had a huge impact on their quality of life.”

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