1. NEW OPTIONS IN PROSTATE CANCER TREATMENT Presented by Triangle 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 cancer in 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 spread outside 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 with other 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 radiation 1,2 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 SEEDS BIG 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 Associates Cathy Stutts, RN 919-313-3609 cathys@triangleurologync.com