NEW OPTIONS IN PROSTATE CANCER TREATMENT Presented by Triangle Urology Associates, P.A.

1. NEW OPTIONS IN PROSTATE CANCER TREATMENTPresented byTriangle Urology Associates, P.A.

2. PROSTATE CANCER:The #1 cancer in males • Second leading cause of cancer related deaths among men • 1 out of 6 men has a chance of developing prostate cancerin his lifetime • Majority of cases occur after age 65

3. EARLY DETECTION IS KEY • Disease has “silent” progression in early stages • 21% of cases are discovered after disease is advanced • If detected early, cure rate is nearly 100%

4. PROSTATE ANATOMY • Walnut-sized gland below the bladder • Surrounds the urethra

5. PROSTATE CANCER WARNING SIGNS • Weak or interrupted urine stream • Difficulty urinating/frequent urination • Painful/burning urination • Blood in urine • Pain in back, hips, pelvis • Often no symptoms at all!

6. DIAGNOSING PROSTATE CANCER • Digital Rectal Exam (“DRE”) • Prostate Specific Antigen (“PSA”) blood test • Screening (DRE, PSA) is recommended: • Annually for men 50+ years • At age 40 for higher risk patients (African-American, • Family history of prostate cancer) • Elevated PSA levels suggest possible presence of cancer, gland enlargement or infection

7. IF PSA OR DRE IS ABNORMAL • Additional tests may be done to confirm presence of cancer: • Imaging of the prostate (ultrasound, MRI, CT) • Needle biopsy - small tissue sample obtained with a needle and analyzed in lab

8. AFTER THE DIAGNOSIS • Grading the tumor • Staging the cancer • Considering a treatment plan

9. GRADING THE TUMOR • Determines how fast the tumor is growing • Rated on a “Gleason Scale” of 2-10 • Most localized prostate cancers are low-to-intermediate grade

10. CANCER STAGING • Measures how far cancer has spreadoutside the gland • Two common staging systems: • TNM Staging System • Stage I-IV (A-D)

11. THE GOOD NEWS If detected early, prostate cancer is highly treatable!

12. TREATMENT OPTIONS • Watchful waiting • Surgery • External beam radiation therapy • Hormone therapy • Brachytherapy (seed implantation) • Combination Therapy

13. WATCHFUL WAITING • May be used for slow-growing tumors or elderly patients • Requires frequent check-ups on progress of tumor • Does not include any active treatment

14. SURGERY (RADICAL PROSTATECTOMY) • Involves removal of entire prostate gland and surrounding tissue • Can be very effective if cancer is confined to gland • Requires hospitalization • Side effects include possible impotence and incontinence

15. EXTERNAL BEAM RADIATION • Uses radiation (x-ray) to destroy cancer cells • A common treatment technique in early cancers • Requires daily treatment for 8-9 weeks • Side effects may include: • Incontinence – Urinary or rectal problems • Skin irritation • Impotence • Fatigue and bowel irritation

16. HORMONE THERAPY • Lowers level of male hormones (androgens) to shrink gland and slow tumor growth • Sometimes used in combination withother therapies • A treatment but not a “cure”

17. Now, an effective treatment option that also helps preserve patient quality of life: Brachytherapy

18. WHAT IS BRACHYTHERAPY? • Implantation of radioactive “seeds” directly into the prostate gland • Seeds deliver high-dose radiation directly to the site of the cancer • Seeds release radiation over 3-9 months

19. BRACHYTHERAPY: PROVEN EFFECTIVE • Modern technique developed in the 1980’s • Involves a team of specialists - urologist, radiation oncologist, medical physicist • Over 100,000 patients treated successfully • Published studies show results comparable to surgery and external radiation1,2 1. Ragde H, Korbe LJ, Elgamal AA, et al. Modern Prostate Brachytherapy: Prostate Specific Antigen results in 219 patients with up to 12 years of observed follow-up. Cancer. 2000;89(1):135-141. 2. Sharkey J, Chovnick SD, Behar RJ, et al. Outpatient ultrasound-guided Palladium-103 brachytherapy for localized adenocarcinoma of the prostate: A preliminary report of 434 patients. Urology. 1998;51(5):796-803.

20. How are We Different? • Piedmont Prostate Center in conjunction with your urologist is the only medical clinic in North Carolina that can offer in office prostate brachytherapy. • No hospitalization required! • The entire procedure is performed in the comfort of the urologist’s office.

21. THE BRACHYTHERAPY PROCEDURE • The entire procedure is usually done in 1-2 hours on an outpatient basis under local pain control. • State of the art equipment and personnel specifically designed or trained for Brachytherapy is brought to you. • No general or spinal anesthesia required! • Usually no catheter required post procedure.

22. SMALL SEEDSBIG ADVANTAGES • No major surgery required • No daily treatments • Normal activity is resumed quickly • Reduced risk of impotence, incontinence • Completely outpatient. No hospitalizations or need for expensive anesthesia.

23. CHOOSING THE RIGHT OPTION FOR YOU • Learn the facts • Talk to us or your doctor • Get annual check-ups: DRE and PSA • Live free of cancer

24. Triangle Urology AssociatesCathy Stutts, RN919-313-3609cathys@triangleurologync.com