If prostate cancer is detected, treatment options may depend on the stage of the cancer, the grade of the tumor, the person’s age, the number of biopsy samples that contain cancer cells, symptoms and the person’s overall health. It is important to talk with your doctor about all of your treatment options before starting a treatment plan.
You have the right to a second, and even third, opinion at any point in your cancer experience. A second opinion can help you confirm your diagnosis, understand your treatment options, provide you with access to clinical trials, and help you determine which health care team you would like to work with.
There are several types of treatment, and some people may receive one or a combination of the following:
- Active Surveillance - This may be recommended if the risks and side effects of possible treatment outweigh the potential benefits. This involves regular checks by your doctor to monitor the Gleason score of your cancer. Doctors may suggest active surveillance in a diagnosis of slow-growing, early stage prostate cancer or in men who are older or have other serious health problems.
Choosing active surveillance means putting off side effects of other treatments. It does have risks however, including reducing the chance to control cancer before it spreads. People who choose active surveillance can always try another approach at any time.
- Surgery - is an option for men with early (stage I or II) prostate cancer, and is sometimes an option for men with stages III prostate cancer. The surgeon usually removes the entire prostate. Sometimes the surgeon removes the lymph nodes in the pelvis.
If cancer is found in the lymph nodes, the surgeon may suggest other treatments after the surgery, such as radiation or hormone therapy. There are several types of surgery, including: Open Surgery, Robotic Laparoscopic Surgery, Cryosurgery and TURP (Transurethral Resection of the Prostate). Some are commonly used and some rarely used to treat prostate cancer.
Ask your doctor to explain the types of surgery and why one type is better for you than another, as well as the risks you may face based on your situation, your age, your body type and your overall health.
After surgery, some men lose control of the flow of urine, and how quickly and how much control they regain depends on many factors. Surgery can also damage the nerves around the prostate, causing impotence (inability to obtain an erection), which sometimes can be permanent. If the prostate is removed, men will no longer be able to produce semen and may sometimes want to consider sperm banking before surgery.
- Radiation Therapy - Uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in the following ways:
> External beam radiation. During this procedure, you lie on a table while a machine moves around your body, directing high-powered energy beams to the site of the prostate cancer. Treatment is typically given five days a week for 6-8 weeks.
> Brachytherapy. This involves placing many rice-sized radioactive seeds in your prostate tissue. The radioactive seeds deliver a low-dose of radiation over a long period of time. Your doctor implants the seeds into your prostate using a needle guided by ultrasound.
> Radiopharmaceutical. This type of therapy involves injecting a substance into the vein that goes to sites of cancer and emits radiation at those locations to help kill the cancer cells. It is used for men with advanced prostate cancer.
Side effects from these types of radiation treatment can include painful, frequent or urgent urination, as well as rectal symptoms, such as loose stools or pain when passing stools. Erectile dysfunction can also occur.
- Hormone Therapy - Uses drugs or surgery (removing testicles), and may be used instead of, before, during or after radiation or surgery. This type of therapy is also used when prostate cancer returns after local treatment such as radiation or surgery.
Prostate cancer cells rely on the hormone testosterone to help them grow. Hormone therapy stops your body from producing testosterone, which may cause cancer cells to die or to grow more slowly. Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before and during radiation therapy. It is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind.
There are many types of hormone therapies, including shots and pills. When prostate cancer is advanced and no longer responds to traditional hormonal therapy (e.g., leuprolide, goserelin) that lowers testosterone, additional hormonal therapy drugs may be used (e.g., abiraterone, enzalutamide).
> Hormone therapy options include:
> leuprolide (Lupron®, Eligard®)
> goserelin (Zoladex®)
> triptorelin (Trelstar®)
> histrelin (Vantas®)
> bicalutamide (Casodex®)
> enzalutamide (Xtandi®)abiraterone acetate (Zytiga®)
Some common side effects of hormone therapy includes erectile dysfunction/reduced sex drive, breast tissue growth and sometimes tenderness, loss of bone mass, penis/scrotum shrinkage, hot flashes and weight gain. Hormone therapy can also increase the risk of heart disease.
- Chemotherapy - This type of therapy is most commonly used when prostate cancer has spread and does not respond to hormone therapy alone. Chemotherapy uses drugs to kill cancer cells. For prostate cancer, these are usually given through a vein.
Chemotherapy treatment can take several months, and are known to cause side effects such as hair loss, low blood counts, nausea, loss of appetite, gastro-intestinal problems and others.
Chemotherapy drugs may be used when prostate cancer has spread to distant areas of the body. Chemotherapy may also be an option for cancers that don’t respond to hormone therapy. Chemotherapy options include cabazitaxel (Jevtana®) and docetaxel (Taxotere®). Chemotherapy treatment can take several months, and is known to cause side effects such as hair loss, nausea, a loss of appetite, gastro-intestinal problems, and fatigue.
Chemotherapy has different side effects depending on the type and dose of drugs given and the length of time they are taken. These side effects can include hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, increased chance of infections (due to low white blood cell counts), easy bruising or bleeding (due to low blood platelet counts) and fatigue (due to low red blood cell counts).
Open to Options®
If you are facing a cancer treatment decision, Open to Options® is a research-proven program that can help you prepare a list of questions to share with your doctor. In less than an hour, our Open to Options® specialists can help you create a written list of specific questions about your concerns for your doctor.
- Immunotherapy – This treatment harnesses the immune system to treat cancer. Immunotherapy for prostate cancer is one of the major areas that are currently being tested in clinical trials . Sipuleucel-T (Provenge®) is an immunotherapy vaccine for treatment of minimally symptomatic or asymptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer. For more information on immunotherapy, check out, Frankly Speaking About Cancer: Your Immune System & Cancer Treatment.
- Clinical Trials - You or your doctor may be interested in pursuing a clinical trial for prostate cancer. Clinical trials offer patients the opportunity to benefit from new combinations of therapies while also advancing knowledge about the disease and treatment options.
If your doctor has not mentioned a clinical trial as an option, ask if it is right for you. Although there is much information about clinical trials on the internet, it is important to talk with your doctor so you can find out if the right trial exists for you. Each trial has specific guidelines and eligibility criteria, as well as exclusions based on prior treatments, overall health, and stage of your disease. Your doctor or nurse will also be able to explain to you what participating in a study will entail and how it may affect your care and daily life.