Teal Overview

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Teal Overview

Teal splits into three subtypes: Low-Teal, Basic-Teal, and High-Teal. Treatment is different for each subtype. Low-Teal has only one intermediate risk factor, with all the remaining factors being like those of Sky. Low-Teal is very similar to Sky and...

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Accessing The Medical Chart | Teal

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Accessing The Medical Chart | Teal

Many treatments have irreversible consequences, so it is worth doing it right the first time. It is commonly understood in medical circles that long-term survival is improved by receiving optimal treatment up front...

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The PSA Blood Test | Teal

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The PSA Blood Test | Teal

PSA plays a variety of roles, the most familiar being screening to detect prostate cancer at an early stage. PSA also helps to define the Stages of Blue. Another role of PSA is to detect cancer relapse after surgery or radiation. Lastly, rises or declines in PSA after hormone therapy or chemotherapy help determine whether a treatment is working...

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Prostate MRI and Targeted Biopsy | Teal

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Prostate MRI and Targeted Biopsy | Teal

Multiparametric MRI (MP-MRI) provides a three-dimensional image of the prostate, giving important information about the cancer’s location, size, and how “aggressive” it appears. MP-MRI also greatly increases the confidence that higher-grade cancers are not being overlooked in men on active surveillance. MP-MRI is usually performed without an endorectal coil...

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Color Doppler Ultrasound and Targeted Biopsy | Teal

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Color Doppler Ultrasound and Targeted Biopsy | Teal

In Chapter 4, MP-MRI technology combined with a targeted biopsy was discussed.  This chapter will discuss an alternative type of imaging, called color Doppler ultrasound (CDU). Unfortunately, CDU followed by targeted biopsy is available in only a few centers around the United States. Even so, this chapter will expound the many advantages of CDU for the diagnosis and staging of prostate cancer...

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Body Scans and Other Predictive Factors | Teal

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Body Scans and Other Predictive Factors | Teal

While multiparametric MRI and color Doppler ultrasound are excellent tools for monitoring disease inside the prostate, scanning the rest of the body for cancer that may have spread to the lymph nodes or bones is also critical. Body scans are necessary for every Stage of Blue except Sky...

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Introduction To Treatment | Teal

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Introduction To Treatment | Teal

Once the proper Stage of Blue is assigned (Chapter 1), the different treatments appropriate for that Stage can be considered. Overall, there are four broad categories of treatment available for prostate cancer: observation, local treatments, systemic treatments, and combination therapy...

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Permanent Radioactive Seed Implants

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Permanent Radioactive Seed Implants

Permanent seed implantation, also known as brachytherapy, involves the insertion of small, carefully spaced, radioactive pellets into the prostate. After implantation, the seeds emit a low but continuous energy over a period of...

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High Dose Rate Temporary Seed Implants

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High Dose Rate Temporary Seed Implants

High dose rate brachytherapy (HDR) is done in 4 steps. The first step is placement of catheters into and around the prostate. Once the catheters are in position, the two next steps are called “simulation” and “dosimetry.” Simulation involves taking...

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Combination Therapy For Teal

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Combination Therapy For Teal

The treatment we recommend at Sloan Kettering is dependent upon which subtype of Intermediate-Risk a patient’s cancer falls into (see Appendices I and II). For example, in patients with favorable Intermediate-Risk prostate cancer who are...

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Proton Beam Therapy

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Proton Beam Therapy

Proton therapy is simply using a beam of protons to deliver precision radiation therapy. In a fashion identical to intensity modulated radiation therapy (IMRT), patients are treated daily on an outpatient basis. A typical treatment session lasts...

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Stereotactic Body Radiation Therapy

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Stereotactic Body Radiation Therapy

Stereotactic Body Radiation Therapy (SBRT) delivers a much larger dose of radiation per patient visit than IMRT. SBRT technology is relatively new. Thus, there are fewer clinical trials comparing it with other therapies. Despite this, SBRT has...

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Hormone Therapy Alone As Primary Therapy for Teal

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Hormone Therapy Alone As Primary Therapy for Teal

Prostate cancer cells are dependent on testosterone for their survival, so when testosterone is removed, they shrivel and die. Radiation and surgery can’t cure cancer that has already spread outside the prostate. Only hormone therapy, otherwise known...

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Robotic Assisted Radical Prostatectomy (RARP)

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Robotic Assisted Radical Prostatectomy (RARP)

Surgery has several advantages over radiation and other non-surgical options. These advantages are: 

  1. Examination of the surgically-removed prostate allows for accurate staging, enabling us to make rational decisions regarding the need for immediate treatment after surgery.
  2. Surgery provides relief of obstructive voiding symptoms by getting the prostate out of the way of the bladder.
  3. Overall side effects of surgery are no worse than those of radiation. 
  4. Hormone therapy with TIP will not be necessary (unless after the operation a new, unsuspected degree of cancer spread is detected).
  5. The accuracy of PSA monitoring for relapse is much greater after surgery than after radiation and other non-surgical options. 
  6. Salvage therapy (for recurrence) is effective and safe after surgery. 

State of the Art Robotic Surgery for Prostate Cancer

Robot Assisted Radical Prostatectomy was FDA-approved for prostate cancer treatment in 2001. RARP improves accuracy, reliability, and reproducibility of surgery. Compared to open surgery, blood loss is less, hospitalization time is shorter, and men tend to recover bladder control and sexual function more quickly and to a better degree. 

RARP generally takes between one and a half to three and a half hours. Thirty to sixty additional minutes are required when the lymph nodes are removed. After the operation, men wake up with a catheter that protects the new connection between the urinary bladder and the urethra. Most men will be able to go home from the hospital the following day. The catheter is removed a week later. Most can return to work within 2 to 3 weeks.  

Preventative measures improve the likelihood of recovering erectile function. I recommend regular doses of Viagra. In addition, I recommend at least one dose (100 mg) of Viagra on the third day prior to surgery. There is preliminary evidence that this decreases the shock to the nerves. Six weeks after the operation, if men are getting at least partial erections, then continuing Viagra or a similar drug is probably fine. For men who want to be proactive and for men who are having zero erections, I recommend starting injection therapy. We teach our patients how to inject a small amount of medicine with a tiny needle directly into the penis. It is analogous to diabetics giving themselves insulin. With the correct dose, a full erection will result within about 10 to 15 minutes and last about an hour. This is repeated two to three times weekly at home. It keeps the penis healthy while the nerves are waking up. It will also allow the patient to have intercourse. Men under 65 who have good erections prior to surgery have about an 85 percent chance of having erections (without injection therapy) sufficient for intercourse within a year.  

Twenty-five percent of my patients experience immediate return of complete bladder control. Fifty percent have no need for pads by 6 weeks; 85 percent are dry by 3 months; and 90 to 98 percent by one year. Results are influenced by a patient’s age, preoperative bladder control, prostate size and the nerve-sparing technique used. In the few men who do not regain urinary continence, medical therapy can sometimes be successful (Chapter 12). Death from prostate cancer after RARP is rare; most men recover completely and go on to live full and productive lives. Men who have recurrence after RARP can commonly be treated successfully with radiation.  

 

 


ABOUT THE AUTHOR

Timothy Wilson, MD is a board-certified urologist who specializes in minimally invasive, laparoscopic, and robotic-assisted urologic oncology. He is one of the top six surgeons in the world, in terms of volume, that performs robotic-assisted laparoscopic prostatectomy. Dr. Wilson is a member of the American Urological Association and the Society of Urologic Oncology. Throughout his tenure that spans nearly 30 years, he has published numerous peer-reviewed articles and book chapters in the areas of urologic oncology, urinary reconstruction, and robotic surgery. In 1995, Los Angeles magazine deemed him one of 25 “Doctors who are making a difference,” and in 1998, he was voted “Professor of the Year” by urology residents in training at the University of Southern California School of Medicine.

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Comparing Treatments For Teal

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Comparing Treatments For Teal

Many patients operate under the mistaken belief that doctors are generally similar. However, I claim that medical oncologists like myself are quite different. This is because oncologists have no innate preference for surgery over radiation. They perform...

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Side Effects From Treatment, an Overview

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Side Effects From Treatment, an Overview

Patients in Sky are still frequently advised to have treatment. It behooves them, therefore, to learn about its side effects. Unlike the other Stages of Blue, men in Sky have a choice—the option of postponing treatment by pursuing active surveillance. Therefore...

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Sexual Dysfunction

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Sexual Dysfunction

Erectile dysfunction (ED) is a risk with every type of treatment for prostate cancer, but the exact risk is very specific to each patient. The better a man’s erections are before prostate cancer treatment, the better chance he has of preserving function...

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Surgical Side-Effects Affecting Urination

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Surgical Side-Effects Affecting Urination

Loss of bladder control (urinary incontinence) after surgery can be a devastating complication with a very negative impact on quality of life. The good news is that, with appropriate evaluation and treatment, incontinence is usually treatable. Bladder control problems for...

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