Prostate Cancer Treatment in Cleveland, OH

Our doctors at Cleveland Urology Associates are experienced in every stage and manifestation of the disease and have a very high success rate in treating prostate cancer. A multi-specialty team of specialists from Urology, Radiation and Medical Oncology at our Cancer Center works with the patients to determine the best treatment options available. In addition to Radical Prostatectomy, we perform Brachytherapy (radiation seed implants), Intensity modulated radiation therapy (IMRT), hormonal therapy and chemotherapy.

Call us at (440) 8914-6500

Prostate Cancer Overview

• Prostate cancer is the most common cancer among American men
• Prostate cancer is the third leading cause of cancer specific death among men in the United States.
• This year, 218,890 new cases and 27,050 prostate cancer related deaths are estimated to occur.
• African-American men are more likely to have prostate cancer and more likely to die of it then other Caucasian or Asian men. The reasons for this are still not known.
• By age 50, up to 1 in 4 men may have some cancerous cells in the prostate gland.
• As you age, your risk of prostate cancer increases.
• One man in six will develop prostate cancer during his lifetime.
  It is estimated that one out of every 10 American men will develop prostate cancer before the age of 85.
• The advent of Prostate Specific Antigen (PSA) screening in the early 1990’s resulted in an overall down staging of newly diagnosed prostate cancer, and presently, approximately 77% of prostate cancers are found while they are still localized to the prostate.
• Prostate cancer grows very slowly in most men. In fact, 80% of patients have a 5 year survival rate, and 60% live at least 10 years after the diagnosis is made and proper treatment is implemented.
• Some prostate cancers are very aggressive and deadly. Unfortunately, we are unable to predict their behavior at this time.
• Eventually, the cancer may spread outside the prostate gland to other parts of the body.
• When prostate cancer spreads, they often go to bones and pelvic lymph nodes.

What Is a Prostate?

The prostate is a small, walnut-sized gland located in front of the rectum, behind the base of the penis, and under the bladder. It surrounds the first inch of the urethra, the tube that carries urine from the bladder. Its location allows us to feel through the rectum (during digital rectal examination) the part of the gland where most tumors occur. The prostate is made up largely of muscular and glandular tissues. Its only function is to produce fluid for sperm, which transports the sperm. During the male orgasm (climax) muscular contractions expel the prostate fluid into the urethra. Sperms, which are produced in the testicles, are also propelled into the urethra during orgasm. The sperm containing seminal fluid leaves the penis during ejaculation.

What is Prostate Cancer?

Prostate cancer is a malignant tumor that most often begins in the outer part of the prostate. As the tumor grows, it may spread to the inner part of the prostate and may block the flow of urine. Like any other cancers, prostate cancer can spread beyond the prostate to other parts of the body.

Early prostate cancer usually does not cause any symptoms, as the cancer progresses, however, it may constrict the urethra, and urinary problems may begin. Prostate cancer should not be confused with other common prostate conditions, most commonly known as Benign Prostatic Hyperplasia (BPH). This non-cancerous growth may press on the urethra and cause urinary symptoms. BPH is not cancer, nor does it lead to cancer, but a man can have both BPH and prostate cancer.

What Causes Prostate Cancer?

• The exact cause is not known
• There is evidence that testosterone (male sex hormone) plays an important role. Men with high testosterone levels are at higher risk of developing prostate cancer.
• Diet high in animal fat (red meat and dairy products)
• Obesity
• African Ancestry – African American me are 60% more likely to have prostate cancer
• Blood relatives with prostate cancer (Father or Brother). If your father or brother has prostate cancer, you are twice as likely to have prostate cancer.

What are the symptoms of Prostate Cancer?

In the very early stages of prostate cancer, there are no symptoms.

When symptoms do develop, they vary according to the size and location of the tumor and are often the same as those for Benign Prostatic Hyperplasia (BPH). In fact, these symptoms would indicate BPH rather than cancer. Therefore, symptoms are not a reliable way to tell whether or not a man might have prostate cancer. Symptoms of prostate problems include:

• Frequent urination, especially at night
• Weak urinary stream
• Slow urinary stream
• Difficulty emptying the bladder
• Blood in the semen
• Blood in the urine
• Difficulty in starting or stopping urination
• Pain and burning on urination
• Pain in the pelvis
• Back pain or bone pain
• Weight loss
• Loss of appetite

“If you have any of these symptoms, please call your primary care physician or call us to determine for sure whether your prostate condition is benign or cancerous”.

How is Prostate Cancer diagnosed?

• The goal is to identify cancers as early as possible.
• Every man over the age of 40 should have a digital rectal examination as part of his regular annual physical checkup. The physician inserts a gloved, lubricated finger into the rectum to palpate the prostate. Normal prostate is firm and smooth. Almost all prostate cancers begin in that part of the prostate gland that can be easily palpated by rectal examination and if there is a cancer in the prostate. The gland will be nodular, harder and irregular.
• We also recommend that men 50 and over have an annual blood test called Prostate Specific Antigen (PSA)
• If there is family history of cancer of the prostate in father or brother, screening PSA should begin at age 40.
• If either digital rectal examination or PSA test is abnormal, we recommend further evaluation; Transrectal Ultrasonography of Prostate and Needle Biopsies.

What is PSA?

• PSA – Prostate Specific Antigen is a protein produced by the prostatic epithelium and periurethral glands. PSA is secreted into seminal fluid in high concentration and it is also found in low concentration in blood.
• PSA levels under 4 ng/ml are generally considered normal, while levels over 4 ng/ml are considered abnormal.
• The amount of PSA in the blood normally increases as a man’s prostate enlarges with age.
• PSA levels between 4 and 10 ng/ml indicate a risk of prostate cancer higher than normal. When the PSA level is above 10 ng/ml, risk of prostate cancer is much higher.
• An elevated PSA does not always indicate cancer, nor does normal PSA means that you do not have cancer (a false negative result).
• PSA is not a perfect test.
  The blood test does not tell you whether or not you have prostate cancer.
• Some men with prostate cancer do not have an elevated PSA, and many men with an elevated PSA do not have prostate cancer.
• PSA levels may be high if you have prostate cancer, prostate gland is enlarged (BPH) or there is inflammation in the prostate (prostatitis).
• PSA levels may be lower in patients who take Proscar or Avodart.

Several other ways to look at PSA have been developed to avoid the short comings of PSA (false positive and false negative). They include:

• Age – specific reference ranges: PSA increases with age primarily because of increase in prostate size, and age-adjustment of PSA is a means of accounting for this size increase with age. Age-adjustment of PSA – compared to the use of a single PSA cutoff for all ages – may lead to increased cancer detection in younger men thus avoiding false negative PSA.
  • Age 40 to 50 years 0 to 2.5 ng/ml
    Age 50 to 60 years 0 to 3.5 ng/ml
    Age 60 to 70 years 0 to 4.5 ng/ml
    Age 70 to 80 years 0 to 6.5 ng/ml
• PSA Velocity – The rate of rise of the PSA over time is called PSA velocity
  A change in PSA of more than 0.5 ng/ml per year indicates presence of prostate cancer.
• PSA Density – The vast majority of men (80%) with elevated PSA have serum levels in the range of 4.0 to 10.0 ng/ml
  In these men, the most likely reason for elevated PSA is BPH not prostate cancer.
  The ratio of PSA to prostate gland volume measured by is ultrasound called the PSA density.
• Total and Percent Free PSA – Approximately 90% of the PSA in the blood is bound to protein and lesser amount is free (not bound to protein)

Studies have suggested that patients with prostate cancer have lower percentage of Free PSA than patients with benign disease. If your serum PSA is between 4-10 ng/ml your free PSA should be at least 25% of Total PSA value.

“PSA is the single test with the highest positive predictive value for cancer”

If the results of digital rectal examination of prostate or blood test (PSA) suggest that you may have prostate cancer, we would suggest that you should consider Transrectal Ultrasonography and Ultrasound guided Biopsy of the Prostate.

When PSA test is Indicated and Why?

• Screen men for prostate cancer. Screening is usually done for men older then age 50 or for those who have a higher-than-normal risk of developing prostate cancer (such as man with family hisotry of prostate cancer). A PSA test is an effective screening test for prostate cancer.
• Most insurance plans only allow one screening PSA test in one calendar year.
• Monitor the response to treatment. Successful treatment of prostate cancer usually causes PSA levels to drop significantly. The amount of PSA is often undetectable. PSA levels that rise after treatment indicates that the cancer is spreading to other parts of the body or has recurred at the prostate site. We monitor serum PSA every 3-6 months.
• Monitor levels of Total PSA as well as % Free PSA in patients who have history of having elevated PSA but biopsies were negative. We recommend digital rectal examination as well as serum Total and % Free PSA in these patients every 3-6 months.

What is Transrectal Ultrasound?

Transrectal ultrasound is the examination of prostate using a machine called ultrasound. We insert a finger like probe into the rectum to examine the prostate. Ultrasound creates a picture of prostate using high-frequency sound waves. These sound waves come out of the probe and are transmitted through body tissues. The sound waves then bounce off the tissue and return to the probe. These returning sound waves are called echoes and are translated and recorded into photographic images.
Transrectal Ultrasonography provides excellent visualization of the prostate and abnormalities that may be present in the prostate. We can also easily guide the biopsy needle under ultrasound guidance into the prostate where cancer is suspected.

The ultrasound machines in our offices are capable of doing color doppler studies and three dimensional (3D) reconstruction of the gland. Usually there is increased blood flow within the cancerous lesion or adjacent to the lesion and color doppler helps us precisely guide the biopsy needle into the lesion for accurate biopsy.

Transrectal ultrasonography is also used to estimate the prostate volume accurately to calculate PSA density.

Transrectal ultrasonography also provides images sensitive enough to defect capsular involvement and extension of cancer into the seminal vesicles (staging of cancer).

What is biopsy and how is it done?

Once we find an abnormal area in the prostate on ultrasound, we need to remove small pieces of prostate for pathological examination called prostate biopsy.
While the ultrasound probe is in the rectum, a biopsy needle is inserted through the probe and under the ultrasound guidance, biopsies are performed. Six to twelve tiny pieces of tissue are taken from the prostate. These pieces of prostate tissue are then sent to a laboratory where a pathologist who is an expert in prostate cancer examines these pieces under the microscope to determine

• Whether cancer is present
• Evaluate microscopic features of cancer (Gleason Score)
• Whether suspicious lesions are present (PIN)
• Or the biopsy is negative for cancer
• Whether inflammation is present
• There is absolutely no pain or discomfort during this procedure. We have board certified anesthesiologist on our staff who will administer mild sedation, so that you will have no pain.

What happens if my biopsies comes back negative?

Just because your biopsies are negative, does not mean that you do not have cancer in your prostate. You need to be seen on a regular basis for digital rectal examination and PSA testing. If there is significant change in your PSA, we may suggest repeat biopsies. The average risk of finding cancer in a repeat biopsy following a benign diagnosis is about 18%.

What is prostate intraepithelial neoplasia (PIN) or atypical or suspicious cells on biopsy?

In about 10% of prostate needle biopsy reports, the pathologist will tell us that the final diagnosis is neither benign nor malignant. They describe this condition as

• High Grade Intraepithelial Neoplasia (High Grade PIN)
• A pre-malignant condition
• Biopsy should be repeated soon
• 25% risk of cancer on repeat biopsy
• Low Grade Intraepithelial Neoplasia
• Repeat biopsy is not indicated unless there is a rise in PSA
• Atypia
• Repeat biopsy should be done as risk of having cancer is about 40%

In these difficult cases, pathologist will use specific stains to determine the exact diagnosis.

What happens if my biopsy shows cancer?

If a prostate cancer is found we need to determine the stage of the cancer, whether it is contained within the prostate, or beyond the prostate gland into the surrounding tissues or had spread into the lymph nodes and bones (called metastases). In order to rule out metastases we may perform bone scan, CT scan, MRI, prostate scan and other follow-up imaging studies.

Based on these studies we describe cancer of the prostate in four stages.

Stage I: Low grade cancer discovered incidentally during an operation for benign prostatic hyperplasia (BPH). Cancer is present in less than 5% of the tissue removed.

Stage II: Cancer is confined within the prostate

Stage III: The cancer extends outside the prostate into the seminal vesicles

Stage IV: Cancer has invaded other pelvic organs, or has spread to the lymph nodes or bones.

What determines how my cancer is going to behave?

There are many factors that influence whether cancer will remain dormant in the prostate or will grow outside the prostate into the surrounding tissues and spread into the lymph nodes and bones:

• How high is PSA
• Whether PSA was rising over time
• Tumor volume in the prostate
• Patients age
• Gleason score

Gleason grading system or commonly called Gleason score is the most commonly accepted and relates to clinical outcome. In assigning a grade to a cancer pathologist assign a primary grade and a secondary grade (from 1-5) Gleason score is combination of these two grades (from 2-10). Gleason score of 2-4 represent will differentiated cancer with very good prognosis. Gleason score of 5-6 represent moderately differentiated tumor with good prognosis Gleason score of 8-10 are poorly differentiated tumor with poor prognosis. Gleason score 7 could be 3+4=7 (good prognosis) or 4+3=7 (poor prognosis).

How is Prostate Cancer treated?

The optimal treatment remains a subject of great debate, particularly treatment of localized cancer, because of the uncertainty surrounding the relative efficacy and various treatment modalities. At Cleveland Urology Associates, our doctors have a wealth of knowledge and expertise to offer you when it comes to making the best decision about treating your cancer. We are dedicated to providing state-of-the-art compassionate care to men with prostate cancer. We tailor your treatment plan, taking into consideration, your age, your general health, your life expectancy, the grade and the stage of the cancer, PSA level, the Gleason’s score and tumor volume. Because all treatment modalities have some risks and side effects, we spend great deal of time to discuss all these options and focus on balancing the goals of treatment with the risks of lifestyle alterations. We help patients weigh the benefits and potential side effects of the treatment. At Cleveland Urology Associates, we offer all treatment options for prostate cancer – surgery, external beam radiation therapy, chemotherapy, watchful waiting. Prostate cancer treatment is not one size fits all. We hope this information will give you some realistic expectation.

The treatment of localized Prostate Cancer

What is localized prostate cancer?

• Cancer is confined to the prostate
• Cancer is potentially curable in a vast majority of patients, either by surgical removal of the prostate gland or use of radiation to kill cancer cells

Problem!

Prostate cancer which appears to be localized according to all of the tests performed, may in fact not be localized at all; cancer has penetrated the prostate capsule (locally advance) or there are microscopic cells spread to other parts of the body (metastatic disease). There are four basic types of treatment options available for localized prostate cancer.

• Watchful waiting
• Radical Prostatectomy
• Radio-therapy
• Cryotherapy

In addition, we also use selected patients adjuvant or neoadjuvant hormone therapies in combination with surgery or radiation.

Watchful waiting

Watchful waiting has been advocated as a reasonable approach for some men with prostate cancer. This treatment choice has generally been reserved for older patients with significant medical illnesses who are not expected to derive benefit from definitive treatment. However, there has been much controversy about this choice – largely related to exactly which patients are appropriate for definitive treatment with radical surgery or radiation therapy.

What is the benefit?

You do not have to take any risks associated with the treatment.

What is the risk?

You could be unlucky. You could have a form of prostate cancer that progresses quickly and the time you or us discover this, the cancer has spread beyond the prostate and is therefore incurable. Before you decide whether watchful waiting or definitive treatment is the best option for you, consider these questions:

• How old are your and do you have other significant health issues; ie: high blood pressure, diabetes, obesity, heart attack, coronary artery disease, stroke?
• How long do you expect to live?
• What is your present quality of life?
• How well will you deal with impotence?
• How well will you deal with incontinence?
• How well will you deal with the possibility that if you don’t have treatment you may be living with cancer for years and may die from complications of cancer.

You do not have to make your decision in a hurry. A couple of weeks or even a couple of months is not likely to have any adverse effect on your treatment or on the stage of the disease. If you choose watchful waiting, we monitor our patients very carefully and start treatment at the first sign of progression of cancer based on symptoms, physical examination, PSA measurements and other radio-logical studies. In our experience up to 40% of men on watchful waiting may require treatment with three to five years. Studies have shown that men with diagnosis of prostate if not treated, 55% will die from cancer.

Surgery

Surgical removal of the prostate or radical prostatectomy is a recommended treatment options for patients whose cancer is localized, or confined to the prostate, and those patients who are younger and have a high-grade cancer.

What is radical prostatectomy?

Radical prostatectomy is a major surgical procedure to remove the entire prostate gland, along with both seminal vesicles , both ampule and some surrounding tissues and pelvic lymph nodes. This is then followed by appropriate reconstruction of the urinary system (connect the bladder opening to the urethral opening) in order to allow normal urination.

Why should you choose radical prostatectomy?

If you are in good health and you are young, surgery is a very good options for you. If all the cancer is removed during surgery, you are most likely cured.

What are the risks of radical prostatectomy?

Surgery of this kind does have few risks and complications and these are

• Blood loss. You may need blood transfusion. We will ask you to donate two pints of your own blood for possible use during surgery.
• Urinary incontinence
• Impotence
• Infection
• Urethral stricture
• Complications related to anesthesia
• Pain and discomfort
• Need for hospitalization
• Catheter for 1-2 weeks
• Inability to cure all on whom we operate (in some patients, despite all testing, cancer may not be localized).

Radical prostatectomy can cure patients with localized disease. However, in spite of all diagnostic modalities we have, studies have shown that up to 30% of patient who were thought to have localized disease – were under staged and they have locally advance disease (cancer going through the prostate capsule). Also, almost 20% of patients with pathologically organ-confined cancer will experience an early relapse of cancer despite successful treatment of the primary cancer by surgery. Relapse occurs locally in about 19% of the cases, at a distant site in about 20% and by PSA elevated in about 60% of cases. In patients in whom only PSA is elevated after definitive treatment is called biochemical failure.

What are different ways surgery is performed?

• Retropubic prostatectomy (open): An incision is made int he lower abdomen. Prostate gland, seminal vesicles and pelvic lymph nodes are removed and the bladder is connected to the urethra so that patient will b able to urinate in the normal fashion. This is a relatively short procedure (60-90 minutes).
• Radical perineal prostatectomy (open): An incision is made in the perineum. Prostate gland and seminal vesicles are removed and the bladder is connected to the urethra. With this approach lymph nodes cannot be removed. This is also a relatively short procedure (60-90 minutes).
• Laparoscopic radical prostatectomy: In this procedure, five small incisions are made. Through these incisions camera and instruments are introduced in the abdomen and prostate gland, seminal vesicles and lymph nodes are removed. The bladder is connected to the urethra. Generally this is a long procedure requiring 2-3 hours.
• Robotic radical prostatectomy: This operation is very similar to laparoscopic radical prostatectomy. The difference is instead of us operating instruments, there is a robotic arm to guide all instruments and we control the movement of robotic arm. Usually this is a very prolong procedure requiring 3-4 hours.

What is “nerve-sparing” radical prostatectomy?

There of two sets of nerves and blood vessels called “neurovascular bundles” which pass to the penis. These neurovascular bundles are essential for the ability to have and maintain erection for men. These neurovascular bundles are located very close to the prostate capsule between the prostate gland and rectum. If not very careful during removal of the prostate, these neurovascular bundles can easily be damaged resulting in sexual dysfunction. In carefully selected young patient with localized disease, it is possible to protect one of both neurovascular bundles. However, we have to be very careful not to leave cancer cells behind in process of sparing nerves. The goal of the treatment is to get rid of the cancer in a very careful but thorough way and not to worry about impotency.

Radiation Therapy

Radiation therapy is commonly used in patients with prostate cancer.

• For early stage disease, patients have a choice between radical surgery and radiation, with similar outcomes.
• Radiation therapy can also be combined with hormonal therapy for intermediate risk disease.
• Radiation therapy is also used in advanced stages of prostate cancer to treat painful bone metastases.

There are two types of radiation therapy used for prostate cancer.

1. External beam radiation
2. Brachytherapy

External Beam Radiation Therapy

External beam radiation therapy uses a linear accelerator to produce high energy x-rays which are directed in a beam toward the prostate.

What is radiation therapy and how does it work?

• External beam radiation is a special kind of energy produced electronically by a special machine called linear accelerator.
• This energy is then carried by waves and focused on the cancer site.
• External beam radiation is a completely non-invasive technique. Radiation is invisible, tasteless and odorless.
• No radiation remains with the patient after treatment.
• Radiation therapy works by damaging or destroying cells that are actively reproducing. Tumor cells reproduce more quickly and more often than the normal cells, and are therefore more likely to be affected by radiation. Normal cells at the time of treatment are also affected by the radiation, possible leading to side effects. Unlike cancer cells, however, most normal cells can recover with little or no permanent damage.

What is intensity modulated radiation therapy IMRT?

IMRT is an advanced form of external beam radiation. It is used to further focus radiation beams, with the goal of increasing the dose of to the prostate while sparing normal tissues. IMRT has 80-100 tiny lead “leaves” on each side of the beam that are moved in or out to define the treatment field with pin-point accuracy.

This breakthrough technology for delivering image guided radiotherapy is now available in Cleveland at Cleveland Urology Associates Cancer Center offering new hope to patient who are battling prostate and other urological cancers.

Intensity modulated radiation therapy (IMRT) is the most technologically advanced, most precise method of external beam radiation therapy available.

Recently, we also installed a Dynamic image guided radiotherapy (IGRT). This new technology combines a state-of-the-art treatment machine with sophisticated digital imaging tracking and monitoring tools, enabling us to deliver the most accurate treatment possible.

This new treatment system at Cleveland Urology Associates Cancer Center incorporates a high quality imaging device that enables us to position patients very precisely and to deliver the radiation dose directly to a targeted area.

Our linear accelerator is housed in a special treatment vault and the patients are monitored via closed-circuit television. Sophisticated image matching software shows patient anatomy on computer monitors in a control console outside the treatment room.

IMRT & IGRT is a new form of radiation therapy that uses computer-generated images to plan and then deliver more precisely focused radiation beams to cancer cells than is possible with conventional radiotherapy. With capability at Cleveland Urology Associates Cancer Center we can deliver a precise radiation dose that conforms to the shape of the cancer, while significantly reducing the amount of radiation to surrounding healthy tissues. Consequently, the technique can increase the rate of cancer control while significantly reduce adverse side effects.

Treatment Process

The treatment process consists of several steps:

Consultation with our associate radiation oncologist at Cleveland Urology Associates Cancer Center located at 19250 Bagley Rd, suite 106, Middleburg Hts, OH 44130. Telephone number is 440-826-0966. We will make this appointment for you as soon as you decide to proceed with radiation therapy for management of your prostate cancer.

Our team will have access to all your medical records including report of your prostate biopsies and any other x-rays we have performed. Our team will review your medical history, pathology reports and all x-ray reports, conduct a physical examination and set an appointment for you to begin the positioning and imaging process.

Treatment preparation

• Special molded devices that will help you maintain the same position everyday during the treatment are developed.
• Colored ink will be used to mark your skin, to assist in positioning for treatment by aligning the radiation equipment with the targeted area.
• A special CAT scan and MRI may be done.

Simulation and treatment planning

The simulation is a specialized radiation planning CT scan, which is performed while you are lying on your back on the simulation table. All of your pelvic organs are delineated and your pelvic anatomy is recreated in the computer in 3-D. Using all of this information, Dr. Field and radiation physicist will then work together to design the best IMRT treatment plan that optimizes the dose to the prostate and minimizes the dose to the bladder and rectum. The planning and quality assurance process may take several weeks to complete.

Treatment Delivery

• After the plan meets the established rigorous standards, you will be notified by our staff and an appointment will be made for verification films and then the daily treatment will start.
• Treatment is usually given five days a week for 6 or 7 weeks.
• No treatment will be given on weekends, so that the normal cells will recover.
• The total dose of radiation and the number of treatments you will need – will depend on the size and location of the cancer, the grade of cancer, your general health and other factors.
• Each day, you will arrive for treatment at the designated time, and the radiation therapist will position you on the treatment table.
• The therapist can visualize the prostate, the table position is adjusted based on the prostate location.
• You make notice laser lights in the room, these help the therapist to position you properly on the treatment table.
• The actual treatment is delivered using a linear accelerator and a multileaf collimator. The collimator is a modulating device that comprises as many as 120 computer controlled, tungsten “leaves”, or finely shaped plates. It attaches to the head of the linear accelerator at the point where the radiation beam comes out. During treatment, the collimator leaves move across the beam, blocking it in different places for differing amounts of time, according to the treatment plan. This allows to customize the dosage, so that some parts of the treatment area are given higher doses than other parts.
• The daily treatment sessions usually last about 15-20 minutes.
• You will be monitored by our therapist via a close circuit camera.
• Dose delivery itself takes only few minutes.
• The radiation treatment is invisible and you will not feel it.
• The linear accelerator emits a buzz as it produces the radiation beams.
  It is important to lie as still as possible during this time, so that the radiation dose to delivered to the exact targeted area each time.
• The linear accelerator will move around you.
• After treatment, you can resume normal activity without limitations.

Prostate cancer center at Cleveland Urology Associates is the most comprehensive facility of its kind in North-East Ohio. Specially trained Board Certified Radiation Oncologist and our support staff are skilled in both standard and unique radiation therapies. We are constantly seeking innovative ways to use existing technology and identifying new therapies to help our patients. Our center is also committed to discovering newer and better methods for detecting, treating and preventing prostate cancer. Patient centered care is our philosophy. The cancer centers has easy accessibility and flexible scheduling lets you make appointments that fit into your routine.

We realize that there is more to your cancer treatment than radiation. Our Cancer Center has:

• Easy parking
• Easy access from highways and main roads
• Complimentary rides from and to your home
• Complimentary housing if needed
• Nutritional guidance
• Educational programs

What are the side effects from radiation therapy?

Since external beam radiation therapy in entirely non-invasive, you will not have any side effects or feel anything after treatment in first few weeks. As treatment progresses, you may have side effects:

• Mild fatigue – usually resolve in few months
• Bladder irritation, difficulty voiding, hesitancy, slow urinary stream – usually relieved with medications
• Rectal irritation or diarrhea – usually relieved by diet and medications.
• Mild skin irritation.
• Long-term side effects are very rare.
• We will constantly monitor you and treat any possible side effects.

What type of follow-up care is needed?

Initially both Dr. Field and we will see you for follow-up. But after 3-6 months you will continue to see us for routine care every three months for physical examination and serum PSA determination. It can take up to 2 years for PSA to decline to its minimum value after radiation therapy.

What is HIFU?

HIFU is a precise and targeted therapy that reduces the risk of complications and impact to quality of life caused by surgery and radiation. HIFU uses ultrasound energy, or sound waves, to heat and destroy specifically targeted areas of tissue. During HIFU, the sound waves pass through healthy tissue without causing damage. However, at the focal point of the sound waves the tissue temperature rises rapidly to 90 degrees Celsius destroying the targeted tissue. The same principles are used when light is focused through a magnifying glass.

With HIFU, physicians have the ability to target and treat a small amount of tissue, which minimizes damage done to areas around the prostate. This helps preserve normal urinary function and minimizes risk of erectile dysfunction.

HIFU was cleared by the FDA for prostate tissue ablation in October 2015; however, more than 50,000 men have been treated with HIFU globally. HIFU technology has previously been used successfully since the 1970s to treat other malignancies, including liver, kidney, breast, and pancreatic cancer.