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At USC we believe your treatment should be a choice made between you, your family and your doctor. Once we determine the stage and severity of the prostate cancer, we can help you make the choice between surgery, radiation and active surveillance.
At USC we offer the latest in robotic and laprascopic surgery to treat prostate cancer. We were the first institution in California to offer the latest generation of the da Vinci Surgical Robot in our operating room. Our team of doctors has performed more than 6,000 radical prostatectomies and we continue to have excellent outcomes.
Surgery
A radical prostatectomy involves removal of the prostate gland and the seminal vesicles. This also usually involves removal of the lymph nodes that drain the prostate. Whether done through a larger open incision or using smaller cuts and longer instruments with the robotic approach, our ultimate goal is to remove the cancer. Based on your medical history and preferences, our doctors will guide you in making the best decision if you choose surgery. As with any procedure, radical prostatectomy comes with certain risks and possible complications. Our doctors will speak with you during your consultation to make sure you understand these risks before making a decision.
Robotic Radical Prostatectomy:
Robotic radical prostatectomy is a highly precise anatomic surgical procedure with excellent outcomes to optimally preserve erections and continence.
The USC Institute of Urology’s highly experienced minimally invasive urologists have now performed more than 3000 robotic/laparoscopic radical prostatectomy surgeries, which is one of the largest experiences in the country. Our oncologic (cancer-free) and functional (potency, continence) outcomes are amongst the best anywhere.
• Risk stratification and clinical outcomes are highly reproducible
• Negative surgical margins are an important prognostic predictor of overall survival, biochemical and clinical recurrence. In patients with organ-confined disease, our published negative margin rates exceed 95%. In patients with focal extra-prostatic extension (stage pT3a), our negative margin rates with degrees of nerve-preservation are 82%. These outcomes are amongst the best in the literature.
• Local recurrence (<1%), clinical recurrence (<5%), and death from prostate cancer (0.2%) have been uncommon in our patients undergoing radical prostatectomy for stage T1 & T2 disease.
• For our patients, our large experience translates into excellent cancer and quality of life outcomes. In order to minimize nerve damage, we pioneered a novel “energy-free” technique of nerve-sparing radical prostatectomy, often performed with real-time trans-rectal ultrasound monitoring. In patients with excellent erections at baseline, more than 82% regain erections good enough for intercourse at 1-year after surgery.
• We offer robotic radical prostatectomy for select patients with non-metastatic high risk disease, such as Gleason > 8 disease, and patients with focal extra-prostatic extension, in the setting of a clinical trial.
• We are amongst a handful of programs in the country who offer robotic radical prostatectomy in technically challenging scenarios, such as patients who have failed radiotherapy or seed implants, and after transurethral resection of the prostate, hormonal therapy, and prior pelvic surgery such as hernia repair, aortic surgery, and other abdominal surgery.
Radiation
In patients whose health makes surgery too risky, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal:
• External beam radiation therapy is done in a radiation oncology center by our specially trained radiation oncologists, usually on an outpatient basis. Before treatment, a therapist will mark the part of the body that is to be treated with a special pen. The radiation is delivered to the prostate gland using a device that looks like a normal x-ray machine. The treatment itself is generally painless. Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, inflamed bladder, and blood in urine. External beam radiation therapy is usually done 5 days a week for 6 - 8 weeks.
• Prostate brachytherapy or internal radiation involves placing radioactive seeds inside you, directly into the prostate. Because internal radiation therapy is directed to the prostate, it reduces damage to the tissues around the prostate. Prostate brachytherapy may be given for early, slow-growing prostate cancers. It also may be given with external beam radiation therapy for some patients with more advanced cancer. Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea.
Medical Therapy
Medicines can be used to adjust the levels of testosterone, which is called hormonal manipulation. Because prostate tumors require testosterone to grow, reducing the testosterone level often works very well at preventing further growth and spread of the cancer. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread.
Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncologist will usually recommend a single drug or a combination of drugs.
