From standard treatments to emerging technologies, you have many choices to treat prostate cancer. It all depends on your individual circumstance, taking into consideration your age, lifestyle, stage of the disease, and possible side effects. Work together with your cancer care team to discuss treatment solutions and devise an overall plan. It’s important to weigh the benefits of each option against the risks.
Curative options may include radiation therapy or surgery. With less aggressive tumors, active surveillance or watchful waiting with treatment begun only if the cancer advances may be considered. There are also several other therapies that can help control the growth of the cancer, including chemotherapy, hormone therapy, and newer treatments like immunotherapy. In addition, various alternative treatments are being tested in clinical trials.
Weighing Your Options
Since most prostate cancers are found in the early stages when they are growing slowly, you will likely not have to rush into making treatment decisions. Take your time to learn about your options and be sure to ask your doctor if anything is unclear. Talk to your team about the goals of each treatment, what you can expect while receiving it, the likelihood of it being successful, and the possible sexual, bowel, urinary, and hormone-related side effects. This discussion should also address the current state of the disease, such as:
- Whether the cancer has spread to the bones
- Whether Prostate-Specific Antigen (PSA) levels are steady or rising
- Your medical history
- Any other health conditions you may have
For non-aggressive tumors, the usual recommendation is to observe them and treat them once they show signs of progressing. For early prostate cancers that exhibit signs of being aggressive, surgery or therapy may be considered, especially for people who are able to tolerate it. The aim of these standard treatments is to cure the disease.
With more advanced stages, including metastatic tumors, or in those who are unable to tolerate curative therapies, the aim is typically to control the spread of the cancer for as long as possible. Keep in mind that, unlike other types of cancer, advanced prostate cancer has a high chance of being controlled for a long period of time with systemic treatments, often lasting decades. The goal mainly is to preserve the best quality of life while treating the disease.
Also called active surveillance, watchful waiting may be considered for much older men and those with other advanced or life-threatening diseases who are expected to live less than five years. This strategy is about choosing to not actively treat the cancer at the current time.
The patient will have to go back to the hospital routinely to have his PSA levels checked, every year to get a digital rectal exam, and have biopsies done six to 12 months and two to five years after initial surveillance. Of course, the timing can vary depending on the unique elements of the disease. If at any time the tumor appears to advance, active treatment can start immediately.
This method uses high energy rays to destroy cancer cells. Radiation therapy may be used as the primary treatment for prostate cancer as an alternative to curative therapy or after surgery as an adjuvant therapy to kill any remaining cancer cells. It may also be used ass a form of palliative treatment to improve symptoms, but not to cure the disease.
There are two techniques for giving radiation therapy – external and internal. Oftentimes, these two methods are used together. External beam radiation therapy is delivered through the outside of the body and focused on the prostate gland and surrounding tissue. In an internal radiation procedure or brachytherapy, radioactive seeds or pellets are implanted in a tumor. Side effects of both forms of radiation, like painful urination and incontinence, are usually mild to moderate.
Like radiation therapy, surgery is another way to fully cure prostate cancer. It involves the removal of the prostate and some surrounding healthy tissue during an operation. In this case, a urologic oncologist or urologist is usually the doctor in charge of the procedure. Surgical options include:
- Robotic or laparoscopic prostatectomy – This is a highly specialized procedure may allow for a much less invasive operation and shorter recovery time. The surgeon will insert a camera and instruments through tiny keyhole incisions in the patient’s abdomen. While the procedure generally causes less pain and bleeding, there may be urinary and sexual side effects.
- Radical prostatectomy – This involves the removal of the seminal vesicles and the entire prostate. It is possible to spare some nerves during surgery to increase the chance of the patient retaining his sexual function.
- Bilateral orchiectomy – Both testicles are removed in this procedure. This can stop the growth of prostate cancer cells.
This treatment uses drugs to kill cancer cells. The patient can take medication orally or have it injected into their bloodstream. Chemotherapy is usually for advanced cases and not for men with early prostate cancer. Typically, it is given when the disease has spread to other parts of the body.
Male sex hormones, such as testosterone, are basically fuel for prostate cancer cells to grow and spread. Hormone deprivation prevents these cancer cells from getting the fuel they need. Some treatments lower levels of testosterone and other male hormones. Other types block the way those hormones function.
This is a way to use the patient’s own immune system to fight cancer cells. One type, called Provenge (sipuleucel-T), has been developed to treat advanced, recurrent prostate cancer. This is a therapeutic cancer vaccine that is approved for prostate cancer patients that have developed resistance to hormone treatments. It works the way normal vaccines work – by stimulating the body to defend itself from cancer cells.
Combining radiation therapy with immunotherapy appears to have promising results. The dying cells from radiation allow the immune cells to identify tumor-specific molecules so they can hunt them down in other parts of the body.
Think about your options carefully and keep an open mind for complementary and alternative methods. Your cancer care team will be your first source of information and support, so be sure to talk to them about your preferences.