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Treating Prostate Cancer 

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If your doctor has diagnosed prostate cancer, many promising treatments are available.
 
 Active surveillance (also termed expectant management and or watchful waiting)
Prostate cancer is almost always a slowly progressive disease, and many men with prostate cancer will die from causes other than prostate cancer. In general, doctors may decide that older men with a limited life expectancy and those with low-grade small-volume disease may benefit from active surveillance. Surveillance includes periodic PSA levels, digital retal exam, and at times, a repeat biopsy procedure

 Surgery
Radical prostatectomy is a procedure which removes the prostate, the seminal vesicles (two appendages attached to the under surface of the prostate), and the lymph nodes, which drain the prostate. Radical prostatectomy may be performed via several approaches. Traditionally, surgery has been performed through a incision made below the belly button -- this is now termed open surgery. A less invasive approach employs laparoscopic removal or robot-assisted laparoscopic removal which is now commonly called a da Vinci Prostatectomy . This approach to prostatectomy provides access to the internal anatomy through five small incisions. The surgeon can perform a very precise, nerve-sparing operation with the da Vinci Surgical System. For the patient, a Da Vinci Prostatectomy may result in more rapid and more complete return of urinary control and sexual function, and a more rapid return to preoperative activity.

 Radiation
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. External radiation therapy uses a machine outside the body to send radiation toward the cancer. IMRT is the latest technological development which permits delivery of radiation more precisely using higher dose levels. Internal radiation therapy (termed brachytherapy) uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
 
 Cryosurgery
Cryosurgery or cryotherapy is a treatment that uses an instrument to destroy prostate cancer cells by exposing them to a repeated freeze thaw cycle.
 
 HIFU (High Focused Intensity Ultrasound)
HIFU is another method for destroying prostate tissue. It is not FDA approved. It is not currently offered because it does not have a sufficient track record of success and is still under investigation.
 
 Hormone Therapy
The male hormone, testosterone, is a powerful driving force for prostate cancer growth. Medications can be employed to markedly reduce the levels of testosterone to what is termed a castrate state. A castrate state is equivalent to the situation after both testicles are removed (bilateral orchiectomy). Medication is usually tried first to achieve a castrate state, but a surgical procedure, removal the testicles (a bilateral orchiectomy) may be necessary.
 
 Chemotherapy
While surgery and radiation remove, damage or destroy cancer cells in specific areas, chemotherapy works throughout the body to destroy cancer cells that have spread away from the primary tumor. Chemotherapy is also termed systemic therapy.

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