There is no “best” treatment for prostate cancer. Your treatment for prostate cancer will be 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:
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 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 is recommended often as it can be less invasive than surgery. Banner MD Anderson Cancer Center provides the most advanced radiation treatments for prostate cancer, including:
- Intensity-modulated radiotherapy (IMRT): External radiation which is tailored to the specific shape of the tumor, avoiding surrounding normal organs
- Brachytherapy: Tiny radioactive seeds are placed in the prostate very close to the tumor and left permanently
Because the prostate can move around, monitoring is conducted to ensure the radiation treatment is in the right location. Monitoring techniques include ultrasounds, CT or CAT scans (computed axial tomography), implanting gold markers that appear on X-rays and proton therapy.
Prostate Cancer Surgery vs. Radiation Treatments – How to Decide:
The method of treatment recommended will be based on your symptoms and other life factors. Be sure to discuss all available treatment options with your doctor.
Hormone therapy is most often used for late-stage, high-grade tumors (Gleason score of 8 or higher) or for patients with cancer that has spread outside the prostate. About one-third of prostate cancer patients will require hormone therapy (also called androgen deprivation).
The most common types of hormone therapies for prostate cancer are:
- Anti-androgens: These drugs, which include Eulexin® (flutamide or flutamin) and Casodex® (bicalutamide), block testosterone from interacting with the cancer cell. They are taken orally.
- LHRH agonists: These drugs over-stimulate the pituitary gland to release luteinizing hormone-releasing hormone (LHRH). Treatments are injections (shots), which last from one to six months, or implants of small pellets just under the skin. LHRH agonists may cause a spike or flare in the testosterone level before treatment takes effect.
- Orchiectomy: Orchiectomy includes the surgical removal of the testicles. It’s an efficient, cost-effective and convenient method of reducing testosterone, and it is an option if you will be treated with testosterone suppression indefinitely. After this surgery, most men cannot have erections.
Chemotherapy is typically reserved for treating prostate cancer that has spread to other organs and is no longer responding to hormone therapy. The two primary types of chemotherapy treatments for prostate cancer are:
- Taxotere® (docetaxel): One of the standard chemotherapy agents for adenocarcinoma of the prostate
- Cisplatin-based chemotherapy: Used to treat the small-cell variant of prostate cancer
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
- Gene therapy: Genes that are commonly involved in prostate cancer include mutations of the ATM gene or BRCA gene
- 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.
- Targeted therapies: Banner MD Anderson is leading some of the world’s most innovative research. Newer treatments may include photodynamic therapy, targeted alpha therapy or stem cell therapies.
Watchful waiting 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): Including urinary incontinence, leakage or painful urination
- The bowels and rectum: Including irregular bowel movements
- Sexual functions: Including getting erections and fertility
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. That’s why we offer a full range of integrative therapies to help you manage side effects, pain or the emotional effects of treatment. Talk to your doctor about the available options for supportive care throughout and after your prostate cancer treatment.