Prostate Cancer & Bladder Cancer

The genitourinary oncology staff at the University of Florida form a comprehensive, multidisciplinary oncology service. Faculty physicians from Radiation Oncology, Urologic Surgical Oncology, and Medical Oncology all maintain clinical services within the Shands Cancer Center, with patients seen by any or all indicated services every weekday. A weekly multidisciplinary tumor conference, or tumor board, is held on Tuesday mornings to review new and active clinical cases, with formulation of treatment recommendations based on both institutional and national clinical research and experience. The genitourinary oncology service both participates in NCI-sponsored treatments protocols and maintains institutional treatment protocols for the management of prostate, bladder, and testicular cancers. Patients treated at the Shands Hospitals and Clinics are closely followed in both prospective and retrospective clinical outcome reviews emphasized by the educational and research commitment of the University of Florida.

Brachytherapy for Prostate cancer

Internal implantation radiotherapy is frequently used to treat patients with prostate cancer. By placing radioactive pellets (commonly called “seeds”) into prostate tissue, a high dose of radiation is given to the cancer with relative sparing of adjacent normal tissues like the bladder and rectum.

At the University of Florida, prostate seed implantation is performed in an operating room by a team of physicians and technical support staff who are specialized in performing the procedure. The radioactive isotope used to make the seeds radioactive is called iodine-125. A prostate seed implant is a permanent implant, meaning that the seeds stay in the prostate forever.

Seeds are inserted into the prostate by placing a series of needles through the skin between the testicles and anus. Anesthesia is used so the patient feels no discomfort during the procedure. A combination of transrectal ultrasound and x-ray fluoroscopy is used to guide seed placement. A seed implant procedure takes about 1.5 hours.

After leaving the operating room the patient spends one night in the hospital. Most patients are sent home the morning after the procedure.

The main side-effect of a prostate seed implant is irritation with urination. Patients often report that they have to urinate frequently and they have to get to the bathroom right away after feeling the urge to urinate. The symptoms usually go away after 4-6 months.

Bladder cancers

Patients with bladder cancer may be treated with either surgical removal of the bladder (cystectomy) followed by chemotherapy or radiation therapy, or by radiation therapy and chemotherapy with the bladder intact. Research studies are frequently in progress involving new ways to treat bladder cancer.

In most cases surgical removal of the bladder is recommended. When treatment with radiation therapy and chemotherapy is likely to be effective, the usual program is to treat the patient with approximately 6 months of chemotherapy and 7 weeks of external beam radiation therapy. Radiation therapy usually begins after 2 months of chemotherapy. Radiation treatments are usually given once a day, 5 days per week, for 7 continuous weeks. Chemotherapy is given several times during the course of radiation treatment. Side-effects of radiation therapy for bladder cancer may include fatigue, diarrhea, and irritation with urination.

Testicular cancers

To establish a diagnosis, most patients undergo surgical removal of the testicle. From the standpoint of needing radiation therapy, testicular cancer can be classified into two main types: seminoma and nonseminoma. Nonseminomatous testicular cancer is usually not treated with radiation therapy.

Seminomatous testicular cancer is treated with either radiation therapy or chemotherapy. When patients have no evidence of tumor outside the testicle (stage I seminoma), the options are to treat the lymph nodes in the abdomen (paraaortic lymph nodes) with radiation therapy or to monitor the patient with frequent CT scans without additional therapy. At the University of Florida, most patients with early-stage seminoma are treated with radiation therapy because the cure rate after radiation therapy in this setting is almost 100% and toxicity is low. The usual radiation therapy program for stage I seminoma involves 3.5 weeks of external beam radiotherapy with treatments given once a day, 5 days per week. Some patients loss their appetite or get nauseated during radiotherapy.

Kidney/renal cell cancer

Cancer of the kidney is usually treated with surgery. Radiation therapy is not used in most cases. Radiation therapy may be useful when tumor remains after surgery in an area that can be safely treated with radiotherapy.

When radiotherapy is likely to be safe and effective patients are usually treated with approximately 6 weeks of external beam radiotherapy with treatments given once a day, 5 days per week. Side effects of radiotherapy in this setting may include fatigue, loss of appetite, nausea, and diarrhea. Medications are usually effective at controlling side-effects so that most patients tolerate radiation therapy well.

The chance of being cured of kidney cancer depends on may factors—most importantly, the size and extent of the tumor. In general, patients with small tumors that are confined to the kidney have a high (approximately 90%) chance of being cured, but those with tumors that extend outside the kidney are cured less than 50% of the time.