Strategies to Improve Treatment - Stage II Prostate Cancer

This content has been reviewed and approved by

Daniel P. Petrylak, MD
Associate Professor of Medicine
Director, Genitourinary Oncology Program
Columbia University Medical Center

Researchers are currently investigating new treatments for stage II prostate cancer. Participation in trials of these treatments will lead to improved therapies. If you wish to participate in a clinical trial, please talk to your doctor about the potential benefits and side effects of the treatment.

Strategies to improve local treatment -Several strategies to improve local treatment of prostate cancer (confined to the prostate) are under evaluation. These strategies do not treat cancer cells beyond the radiation or surgical field.

Newer radiation techniques -EBRT can be delivered more precisely to the prostate gland by using a special CT scan and targeting computer. One exciting technique is the use of three-dimensional (3-D) computer targeting systems to precisely aim the radiation beam at the prostate gland. Through sophisticated software, a 3-D image or "beam's-eye view" of the cancer is generated. Many thin beams of intense x-rays are then aimed at different angles to intersect at all cross sections of the cancer.

This method delivers a concentrated dose directly to the cancer, while the individual beams leave normal, healthy tissue relatively untouched. This technique appears to reduce side effects to the surrounding organs, allowing higher radiation doses to be used.

Combination radiation therapy -Some radiation oncologists are combining EBRT and interstitial seed brachytherapy for patients with stage II or III cancers. EBRT treats the tissues surrounding the prostate gland and lymph nodes where cancer cells may have spread. The interstitial seeds serve to deliver an extra radiation dose to the prostate where the cancer cells have the highest concentration. The combination of internal and external radiation is being evaluated to allow higher doses of radiation to be delivered to the cancer while minimizing side effects to surrounding organs.

Newer radiation machines -Most EBRT uses high energy x-rays to kill cancer cells. Some radiation oncology centers use different types of radiation that require special machines. These different types of radiation, such as protons or neutrons, appear to kill more cancer cells with the same dose of radiation as conventional x-rays. Combining protons or neutrons with conventional x-rays is one method of radiation therapy being evaluated in clinical trials.

Newer imaging techniques -The ability of current imaging technology to detect small areas of cancer within and around the prostate gland and elsewhere in the body is limited. Magnetic resonance imaging (MRI) provides better images of the prostate gland and is able to identify small growths of cancer. MRI can be used to guide interstitial seed placement or determine which patients are best suited for radical prostatectomy.

Strategies to improve systemic therapy -Surgery and radiation are local therapies directed at treating cancer in and around the prostate gland. Treatment administered before or after surgical removal of the cancer is referred to as adjuvant or neoadjuvant therapy, respectively. Over the past several years, many new, more active anticancer drugs and biologic agents have been discovered. These newer anticancer agents are currently being evaluated for use in prostate cancer.

Neoadjuvant hormone therapies -Hormone therapy deprives a man's body of male hormones necessary for prostate cancer to grow. The use of hormone therapy to shrink the prostate cancer before radical prostatectomy or radiation therapy is being evaluated for patients with early stage prostate cancer. Hormonal therapy before radiation therapy results in an average 20 percent shrinkage of prostate volume. This volume reduction may reduce the number of prostate cancer cells and diminish the volume irradiated, decreasing the side effects.

Anti-androgens - Prostate cancer cells are stimulated to grow by male hormones, mainly testosterone. Anti-androgens are agents that block the availability of testosterone to cancer cells. Casodex® (bicalutamide) is an anti-androgen that works by binding to the testosterone receptors on cancer cells, preventing testosterone from binding to the receptors, thereby halting the process of growth stimulation. A study that added bicalutamide to the treatment of patients with early stage prostate cancer found that it reduced their risk of cancer progression by 42 percent.