Prostate Cancer Treatment

Prostate cancer treatment at a glance

• The type of treatment for a prostate cancer depends on the patient’s health, the progression of the cancer and other factors.
• Some prostate cancers do not need to be treated at all.
• Doctors commonly treat prostate cancer with surgery, hormone therapy, radiation therapies such as CyberKnife or chemotherapy.
• Doctors sometimes recommend combining types of therapy to treat a specific cancer.
• All treatments have potential side effects and physicians discuss these with patients before treatment.

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What is prostate cancer and how is it treated?

Prostate cancer occurs when abnormal cells (cancer cells) grow in the prostate. The prostate gland is part of the male reproductive system.

If a patient is diagnosed with prostate cancer, doctors first will identify the stage and grade of the cancer. Then doctor and patient will discuss the treatment options for the patient’s specific situation.

Every treatment has pros and cons. Physicians will consider many things before recommending the best treatment options. These factors include:

• Patient’s age and general health
• How fast the tumor might grow
• Patient’s preferences about treatment
• The size and growth of the tumor (the stage).

For some men, doctors recommend watchful waiting or active surveillance. This means the doctor will observe the tumor to see if it grows and evaluate how the patient feels. Some prostate cancer never needs to be treated. This approach has a risk that untreated cancer might change and grow quickly.

Hormone therapy

Hormone therapy cuts off the supply of the male hormone testosterone. Prostate cancer cells can’t grow without testosterone.

In men whose prostate cancer is advanced, hormone therapy can shrink the cancer and make tumors grow more slowly. For early-stage prostate cancer, doctors may use hormone therapy to shrink tumors before treating them with radiation therapy. Hormone therapy can make radiation therapy more likely to work.

Available hormone therapy options include:

• Stopping the body’s production of testosterone. This therapy uses medications known as luteinizing hormone-releasing hormone (LH-RH) agonists. The drugs block the messages that tell the testicles to produce testosterone.
• Blocking testosterone from cancer cells. Anti-androgen medications keep testosterone from reaching cancer cells. Without testosterone, the cancer cannot grow or grows more slowly.
• Surgically removing testicles (orchiectomy). The testicles produce testosterone, so removing the testicles lowers levels of testosterone.

Hormone therapy’s side effects might include erectile dysfunction, lower sex drive, reduced bone mass, hot flashes and weight gain.

Chemotherapy

Doctors frequently prescribe chemotherapy drugs to kill cancer cells. The treatment can shrink existing tumors or kill cancer cells that are spreading. Some chemotherapy drugs are oral (taken by mouth). Others are delivered by IV (through a vein in the arm).

Most often, doctors prescribe chemotherapy when prostate cancer has spread outside the prostate. Chemotherapy is an option for some men with prostate cancer when hormone therapy isn’t working.

Chemotherapy can cause side effects including hair loss, fatigue, nausea, vomiting, diarrhea, loss of appetite, easy bruising or bleeding, higher chance of infection and mouth sores.

Radiation therapy

Radiation therapy uses energy to kill cancer cells. Men with prostate cancer can receive radiation therapy in a number of ways:

• Traditional beam radiation (from outside the body). A machine sends high-powered energy beams (x-rays or protons) to the cancer. The patient lies on a table to receive the treatment. Most patients take treatment for several weeks, five days a week.
• Brachytherapy (radiation inside the body). To deliver brachytherapy, a doctor uses a needle, guided by ultrasound, to implant radioactive seeds into the prostate tissue. Each seed is the size of a rice grain. These seeds gradually deliver a low dose of radiation. Eventually the radiation stops independently, and the seeds do not need to be removed.
• CyberKnife® radiation therapy. This ultra-precise machine delivers high-dose radiation to targeted body areas — allowing a patient to receive treatment in a shorter amount of time and with virtually no side effects. Learn About CyberKnife

Traditional radiation and brachytherapy’s possible side effects might include painful, urgent or frequent urination, erectile dysfunction, or rectal symptoms, such as painful or loose stools.

Surgical options

Prostate cancer treatment often involves surgery to remove the prostate gland. This is called radical prostatectomy. The surgeon usually removes some tissue around the prostate and a few lymph nodes in the area at the same time.

Surgeons have several options for the procedure:

• Robot-assisted surgery. Robotic prostatectomy allows surgeons to make very precise movements with surgical tools. The surgical instruments are connected to a mechanical device or robot. The surgeon inserts the tools into the abdomen via several small incisions. Then, from a nearby console, the surgeon guides the robot to perform the surgery.
• Surgery via abdominal incision. This surgery is called retropubic surgery. The surgeon removes the prostate gland through an incision in the lower abdomen. This type of surgery may have a lower risk of nerve damage. Nerve damage could potentially cause later problems with bladder control and erectile dysfunction.
• Perineal surgery. To perform perineal surgery, the surgeon makes an incision between the anus and scrotum. The surgeon removes the prostate through the incision. This procedure allows for quicker recovery times. However, with this type of surgery it is more difficult to avoid nerve damage or to remove nearby lymph nodes.
• Laparoscopic prostatectomy. Surgeons use a tiny camera (laparoscope) to guide them in performing surgery. This surgery involves only small incisions in the abdomen. In many cases, robotic surgery has replaced laparoscopic prostatectomy, because this surgery carries higher risk of accidents.
• Cryosurgery or cryoablation. Cryosurgery is a newer procedure that freezes tissues to kill cancer cells. It is used most often when radiation surgery has not succeeded. Using ultrasound images as a guide, the surgeon inserts small needles into the prostate. A very cold gas in the needles freezes the surrounding tissue. Then a second gas in the needles reheats the tissue. Cancer cells – and some surrounding healthy tissue – are killed through the cycles of freezing and thawing.

All surgeries have some risks. In addition to those (bleeding, infection, complications from anesthesia), prostate surgeries have other risks. These include:

• Incontinence
• Erectile dysfunction
• Impotence
• Urethral stricture
• Change in penis size.