Prostate Cancer Treatments

How is prostate cancer treated?

Many options are available to treat prostate cancer. The treatment that will work best depends on several factors. These include your overall health status, age and the grade and stage of the prostate cancer when it is first diagnosed.

Take the time to research your treatment options. Get a second opinion before making a final decision. The most common treatment options for prostate cancer include watchful waiting, surgery, radiation and hormone therapy.

Watchful waiting

Since prostate cancer often grows slowly, older men over age 70 who have the disease may not need treatment. Your physician may suggest taking a wait-and-see attitude. This course of treatment will involve periodic examinations and testing to determine if the cancer has become more aggressive. If it does, active treatment can then be initiated.

Surgical treatments

Surgical treatments are used when the goal is to remove the cancer. A radical prostatectomy involves the removal of the entire prostate gland and surrounding tissue. This operation is performed only if the cancer is confined to the prostate gland itself. The surgery involves making an incision into the abdomen to gain access to the prostate gland. A urinary catheter will be in place after surgery so that urine can be drained from the body. The catheter is left in place for a few weeks. Once it is removed, there may be problems with dribbling and incontinence. This usually improves over time and can sometimes be corrected with medication or other procedures. Impotence or the inability to sustain an erection may result after radical prostate surgery due to impairment of the nerves that control erection. This condition may be temporary or, in some cases, permanent. Discuss these issues with your doctor before consenting to this type of treatment. A nerve-sparing operation, which saves the nerves that control the ability to have an erection, may reduce this risk of impotence.

Transurethral resection of the prostate (TURP) is another surgical option that may be used for men who are not candidates for radical prostate surgery. During this procedure, an instrument is inserted through the urethra and into the prostate where tissue is removed through cauterization. No incision is needed, and a catheter will be left in place for a few days until any urinary bleeding resolves. Incontinence and impotence are not generally associated with a TURP but do occur. The surgery, however, will not cure the patient since the prostate gland is not removed.

Cryosurgery

Cryosurgery is a relatively new treatment for prostate cancer that involves killing the cancer cells through freezing by rods inserted in the prostate.

Radiation therapy

Two types of radiation treatments can be used to treat prostate cancer. They involve external beam radiation, which is similar to getting an X-ray. Treatments, given on a daily basis, last several minutes, and the entire course of therapy may take six or seven weeks to complete. New technology is more exact, using CT scan localization called three dimensional conformal radiation therapy, which offers a 3-D computerized image.

Internal radiation uses radioactive seeds placed directly into the prostate gland. The pellets emit radiation for a few months and then are no longer active.

Radiation therapy does have side effects. Many patients complain of fatigue during the treatments. Others report gastrointestinal symptoms like diarrhea and nausea. Some patients may have difficulty with urination and maintaining erections.

Hormone therapy

Since prostate cancer is dependent upon the male hormone testosterone to grow, reducing the amount of testosterone can cause the tumor to shrink or grow more slowly. Testosterone levels can be reduced through surgery to remove the testicles (orchiectomy), since most testosterone is manufactured here. Hormone pills can also be given to reduce testosterone levels.

Hormone therapy is not a cure for prostate cancer but rather a way to slow its growth. Shots of Lupron® (leuprolide) or Zoledex® (goserelin) (LH-RH agonists) can block the pituitary gland from producing gonadal (testicular) growth stimulating hormones such as testosterone. Hormone treatments may have side effects. They can cause infertility, decreased libido, hot flashes, impotence and osteoporosis (thinning of the bones).

Chemotherapy

The administration of cancer-fighting drugs that kill cancer cells within the body is used only in cases of advanced prostate cancer when the disease has already spread to other organs. The goal of therapy is to reduce pain and hinder the tumor's growth. Recent studies have shown improved survival for patients with metastatic prostate cancer using Taxotere® (docetaxel).

What can I expect following treatment for prostate cancer?

After you complete your initial treatment for prostate cancer, your physician will continue to monitor you closely. You will need to have regular medical examinations that will include screening tests to check for return of the cancer, including the PSA (prostate specific antigen) blood test. If recurrent prostate cancer is found, treatment will depend on what options were chosen originally.

Are there any new developments in prostate cancer research?

HPC1 gene. Scientists have only recently discovered a gene called HPC1 that they hope will soon give additional information about the inherited risk of prostate cancer. One day there may be tests available to identify men at high risk of developing prostate cancer. Early screening procedures could then be implemented.

Angiogenesis. New drugs are being tested that may be able to halt the spread of prostate cancer by interfering with the tumor's blood supply. Anti-vascular endothelial growth factors (VEGF) are being tested in clinical trials.

Prostate cancer vaccines. Several types of vaccines that boost the body's immune response to prostate cancer cells are now being tested in clinical research trials.

Related Articles Basic Facts About Prostate Cancer Who Is at Risk for Developing Prostate Cancer? Screening and Diagnosing of Prostate Cancer Prostate Cancer: Hope for the Future Prostate Cancer Screening: The Question

External Source Dollinger M, Rosenbaum, EH, Tempero M., et al. Everyone's Guide to Cancer Therapy, Fourth Edition, Kansas City, Missouri: Andrews McMeel Publishing, 2002.

This article was reviewed and updated June 2007.

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