Prostate Cancer Treatment and Support

 Prostate cancer treatment is based on your symptoms and customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms. Each treatment option also has its own side effects, which your doctor will review with you.

How Is Prostate Cancer Treated?

Your doctor will discuss the best options to treat your prostate cancer. Several factors are taken into account, such as:

• Your age and general health
• Stage and grade of cancer
• Whether or not the cancer has spread
• Your tolerance for the potential side effects of the treatment

Treatment options include:

Surgery

The most common surgical procedure for prostate cancer is a radical prostatectomy. This is a removal of:

• The entire prostate gland
• Both seminal vesicles
• Part of the urine tube that passes through the prostate

The two main types of surgery are:

• Open: A large incision is made in the lower abdomen to access the prostate.
• Robot-assisted (laparoscopic): This minimally invasive option involves making several small incisions in the abdomen and then using an endoscope and robotic instruments to perform the procedure. This is a common technique in the United States as it may result in fewer complications and shorter hospital stays.

Radiation Therapy

Radiation therapy is often recommended as it can be less invasive than surgery. Banner MD Anderson Cancer Center provides some of the most advanced radiation treatments for prostate, including:

• Intensity-modulated radiotherapy (IMRT): External radiation which is tailored to the specific shape of the tumor, avoiding surrounding normal organs
• Low Dose Rate (LDR) Brachytherapy: Tiny radioactive seed-like implants are placed in the prostate where they deliver a lower dose of radiation to the tumor. These implants are left permanently in the body.
• High Dose rate (HDR) Brachytherapy: Radioactive implants are placed in the prostate and deliver a higher dose of radiation directly to the tumor. These radioactive implants are removed after treatment.

Prostate Cancer Surgery vs. Radiation Treatments – How Do I Decide?

The method of treatment recommended will be based on your symptoms and other factors. Be sure to discuss all available treatment options with your doctor.

Hormone Therapy

Hormone therapy is most often used for advanced, high-grade tumors (Gleason score of 8 or higher) or for patients with cancer that has spread outside the prostate gland. About one-third of prostate cancer patients will require hormone therapy, also known as androgen deprivation therapy (ADT).

The most common types of hormone therapies for prostate cancer are:

• Anti-androgens: These drugs block testosterone from interacting with the cancer cell. They are taken orally.
• LHRH agonists/antagonists: These drugs affect the pituitary gland’s release of luteinizing hormone-releasing hormone (LHRH), which controls testosterone production in the testicles. Treatments are injections that last from one to six months. Pills are also available.  LHRH agonists may cause a spike or flare in the testosterone level before treatment takes effect and may be given temporarily in combination with anti-androgens.
• Orchiectomy: Orchiectomy is the surgical removal of the testicles. It’s a cost-effective and convenient method of reducing testosterone, and is an option if you will be treated with testosterone suppression indefinitely. Unlike medication options, orchiectomies are permanent and irreversible.

Chemotherapy

Chemotherapy is typically reserved for treating prostate cancer that has spread to other organs. The number of chemotherapy treatments recommended will vary, depending on the stage of the prostate cancer and how it responds to the treatment.

Additional Therapies for Prostate Cancer

• Cryotherapy: During cryotherapy for prostate cancer, the tumor is frozen with a long, thin probe inserted into the tumor. In some cases, a focal cryotherapy treatment may be utilized. In focal cryotherapy, only the area that contains the most aggressive cancer cells is treated.
• High-intensity Focused Ultrasound (HIFU): A non-invasive outpatient procedure, HIFU uses highly focused ultrasound waves to target a single tumor or part of a large tumor in your prostate. The heat of the ultrasound waves kills the targeted cancer cells without harming the surrounding tissue.
• Targeted Therapies: Genetic analysis of the cancer’s DNA may identify specific medications likely to help treat your cancer.
• Radionuclide Therapies: Radioactive medications can effectively target and treat prostate cancer which has spread to other parts of the body.
• Immunotherapy: Immunotherapy is a treatment that uses the patient's own immune-cells to target prostate cancer that has spread. Immune checkpoint inhibitors may be an option for patients found to have a high number of mutations on genetic analysis of their cancer. 
• Clinical trials: Our experts take an advanced approach in treating prostate cancer with opportunities to participate in select cancer clinical trials, conducted by renowned research institutions who collaborate with Banner MD Anderson doctors.

Active Surveillance

Active surveillance is an approach that involves closely monitoring the cancer without incorporating any active treatments. This is common for older men or men with additional health problems. The ideal candidate for watchful waiting is a patient with low-grade tumors. Approximately 70 percent of men can maintain this approach for up to 10 years without requiring treatment.

What Are the Side Effects of Prostate Cancer Treatment?

Side effects will vary based on the type of treatment you receive. Most commonly treatments can affect:

• The urinary tract (bladder and urethra): Urinary incontinence, leakage or painful urination
• The bowels and rectum: Irregular bowel movements
• Sexual functions: Impotence (inability to maintain an erection), fertility problems

Sex and Fertility After Prostate Cancer

• Can you have sex when you have prostate cancer? Sex during and after prostate cancer surgery or treatments can be difficult. Impotence, or not being able to maintain an erection, may be a problem after prostate cancer treatment and can be temporary or permanent.
• Can you father a child after prostate cancer? Not surprisingly, some men can be concerned about their fertility when facing surgery for prostate cancer. Treatments typically involve removal of the seminal vesicles and/or cutting the tube that transports semen. If you want to have children in the future, talk to your doctor about banking sperm before your treatment.

Prostate Cancer Treatment Support

Undergoing cancer treatment is not easy. Banner MD Anderson offers integrative oncology and psycho-oncology to assist those who have been diagnosed, their caregivers and family manage the emotional effects of diagnosis and treatment.

Talk to your doctor about the available options for supportive care throughout and after your prostate cancer treatment.

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