High risk of recurrence, prostate cancer (PRCA)
CPT4 code
Name of the Procedure:
High-Risk Prostate Cancer Treatment
Common name(s): Prostate Cancer Surgery, Radical Prostatectomy
Technical/medical terms: Prostatectomy, Androgen Deprivation Therapy (ADT), Radiation Therapy
Summary
Treatment for high-risk prostate cancer often involves a combination of surgery, radiation therapy, and hormone therapy to remove or destroy cancer cells and reduce the risk of the cancer returning. The specific approach may depend on the patient's overall health, age, and the extent of cancer.
Purpose
This procedure addresses high-risk prostate cancer, where the cancer is more likely to spread or recur. The goal is to remove the cancer, reduce the chance of recurrence, and improve long-term survival rates.
Indications
- Elevated PSA levels
- Gleason score of 8-10
- Clinical stage T3 or higher
- Rapidly rising PSA levels after initial treatment
Preparation
- Fasting for 8-12 hours before surgery
- Stopping certain medications as advised by the doctor
- Undergoing pre-operative tests, such as blood tests, imaging studies (MRI or CT scans), and sometimes biopsy
Procedure Description
Surgical Approach (Radical Prostatectomy):
- Performed under general anesthesia.
- An incision is made in the lower abdomen to remove the prostate gland and some surrounding tissue.
- Minimally invasive techniques (robot-assisted laparoscopic surgery) may also be used.
Radiation Therapy:
- External beam radiation or brachytherapy (internal radiation).
- Targeted radiation to destroy cancer cells.
Androgen Deprivation Therapy (ADT):
- Hormone therapy to reduce levels of male hormones that can fuel cancer growth.
- Administered via medication or surgery (orchiectomy).
Duration
- Radical prostatectomy: 2-4 hours
- Radiation therapy sessions: About 15 minutes each, over several weeks
- ADT: Duration varies, often ongoing
Setting
- Radical prostatectomy: Hospital
- Radiation therapy: Outpatient clinic
- ADT: Outpatient clinic or hospital
Personnel
- Surgeons
- Radiation oncologists
- Medical oncologists
- Anesthesiologists
- Nurses and other support staff
Risks and Complications
- Common risks: Infection, bleeding, blood clots, urinary incontinence, erectile dysfunction
- Rare risks: Damage to surrounding organs, severe bleeding
- Radiation-specific risks: Fatigue, skin irritation, bowel issues
Benefits
- Reduction or elimination of prostate cancer
- Lower risk of recurrence
- Potential improvement in survival rates
Recovery
- Hospital stay of 1-3 days post-surgery
- Foley catheter for 1-2 weeks
- Restricted activity for several weeks
- Regular follow-up appointments
- Gradual return to normal activities
Alternatives
- Active surveillance (for less aggressive cancer)
- Focal therapies (like cryotherapy or HIFU)
- Watchful waiting
- Pros: Less invasive, fewer immediate side effects
- Cons: Higher risk of cancer progression or recurrence
Patient Experience
During surgery, patients will be under general anesthesia and will not feel pain. Post-surgery, there may be discomfort and pain managed with medications. Recovery involves a gradual return to normalcy, with close monitoring and support from the healthcare team. Radiation and hormone therapy involve less invasive procedures but may have side effects such as fatigue and hormonal changes.