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Prostate Cancer Treatment Options

The treatment that’s right for you depends mainly on your age, the grade of the tumor, the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Active Surveillance

Active surveillance is the close following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the prostate cancer is growing. Patients are seen more often for PSA tests and a digital rectal exam. If it appears that the cancer is progressing, additional testing may be done. 

This approach is used when the Gleason score is 6 or under, if the patient is older, or he has other medical conditions that would make treatment or the side effects difficult to manage at this time. 

If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every three to six months, at first). After about one year, your doctor may order another biopsy to check the Gleason score. If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option for most men.

Surgery

Surgery is an option for men with early (Stage I or II) prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:

  • Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
    • Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
    • Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
  • Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.
  • Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
  • Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study.
  • TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.

If your prostate is removed, you will no longer produce semen. You’ll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.

Radiation Therapy

Radiation therapy is an option for men with any stage of prostate cancer. Men with early-stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Radiation Oncologists use two types of radiation therapy to treat prostate cancer. Some men receive both types:

  • External radiation: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually five days a week for several weeks. Many men receive three-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.
  • Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. Dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. The seeds give off radiation for months. They don’t need to be removed once the radiation is gone.
    • Systemic radiation is a type of internal radiation therapy which treats cancer with radioactive drugs (called radiopharmaceuticals). These are liquid drugs made up of a radioactive substance. The drugs travel throughout the body and collect in places where the cancer cells are located. 
      • Xofigo® (radium Ra 223 dichloride) is an injection that releases radiation that targets and kills prostate cancer cells. This treatment is commonly used to treat prostate cancer that has spread to bone and no longer responds to hormonal or surgical treatment that lowers testosterone.

Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect.

Hormone Therapy for Prostate Cancer

A patient with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment.

Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body’s main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.

Hormone therapy drugs are used to block the production of androgens and/or testosterone which help fuel the growth of the prostate cancer cells.

Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy. For some men, the cancer will be controlled for two or three years, but others will have a much shorter response to hormone therapy. In time, most prostate cancers can grow with very little or no male hormones, and hormone therapy alone is no longer helpful. At that time, your doctor may suggest chemotherapy or other forms of treatment that are under study. In many cases, the doctor may suggest continuing with hormone therapy because it may still be effective against some of the cancer cells.

Biologic Therapy for Prostate Cancer

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to help restore the body’s natural defenses against cancer.

Chemotherapy

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.