Treatment Options for Prostate Cancer
Possible treatments for prostate cancer include:
Doctors recommend Active Surveillance when the risks and side effects of treatment outweigh the potential benefits. During active surveillance, your doctor will perform regular checks to monitor the Gleason score of your cancer. You avoid the side effects of other treatments but risk missing the chance to control the cancer before it spreads. Doctors may suggest active surveillance for a diagnosis of slow-growing, early stage prostate cancer. It may also be recommended for men who are older or have other serious health problems. People who choose active surveillance can 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 stage III prostate cancer. The surgeon usually removes the entire prostate, and sometimes 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
Ask your doctor to explain the types of surgery and why one may be better for you. Also ask about any risks you may face based on your age, body type or overall health.
Possible side effects of surgery include:
- Loss of control of the urine flow: How quickly and how much control is regained depends on many factors.
- Impotence: The temporary or permanent inability to obtain an erection may be caused by damage to the nerves around the prostate.
- Loss of semen production: If the prostate is removed, men will no longer be able to produce semen. Men may still be able to obtain an erection and have an orgasm. Some men may want to consider sperm banking before surgery.
Radiation Therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy to treat the prostate gland 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 traditionally is given five days a week for 6-8 weeks, although recently shorter course of radiation are being used.
- Brachytherapy. This involves placing many rice-sized radioactive seeds in your prostate tissue. The 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.
- High-dose rate (HDR) brachytherapy. This involves placing tiny hollow catheters into the prostate and then placing radioactive seeds into the catheters.
Side effects from these types of radiation treatment can include painful, frequent or urgent urination. It also includes rectal symptoms, such as loose stools or pain when passing stools. Erectile dysfunction can also occur.
For men with metastatic prostate cancer, another form of radiation is sometimes used. This is called a radiopharmaceutical. This type of therapy involves injecting a substance into the vein that goes to sites of cancer. It then emits radiation at those locations to help kill the cancer cells. It is used for men with advanced prostate cancer. This is not used to treat localized prostate cancer.
Hormone therapy involves drugs or surgical removal of the testicles. This stops the body from producing testosterone. Without testosterone, prostate cancer cells may die or grow more slowly. Depending on the extent of cancer, hormone therapy may be used instead of, before, during, or after radiation or surgery.
In men with advanced or metastatic prostate cancer, hormone therapy can be used to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may help shrink tumors before and during radiation therapy. Hormone therapy can slow the growth of any cancer cells left behind after surgery or radiation therapy. It can also treat cancer that comes back after treatment.
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), 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®)
- apalutamide (Erleada®)
- darolutamide (Nubeqa®)
Some common side effects of hormone therapy include: erectile dysfunction/reduced sex drive, breast tissue growth and sometimes tenderness, loss of bone mass, penis/scrotum shrinkage, hot flashes, fatigue and weight gain. Over a long time hormone therapy can weaken bones and lead to muscle mass loss.
Chemotherapy uses drugs to kill cancer cells. It is most commonly, but not always, used when prostate cancer has spread to other parts of the body or and does not respond to hormone therapy alone. Chemotherapy for prostate cancer is usually given through a vein.
Chemotherapy treatment can take several months, and is known to cause side effects such as hair loss, nausea, loss of appetite, mouth sores, increased chance of infections, easy bruising or bleeding, gastro-intestinal problems and fatigue. Cabazitaxel (Jevtana®) and docetaxel (Taxotere®) are two kinds of chemotherapy often used to treat prostate cancer.
Immunotherapy harnesses the immune system to treat cancer. Sipuleucel-T (Provenge®) is an immunotherapy vaccine for the treatment of minimally symptomatic or asymptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer. Other immunotherapy approaches may be available through clinical trials.
Clinical Trials offer patients the opportunity to benefit from new combinations of therapies while also advancing knowledge about the disease and treatment options. Ask your doctor if a clinical trial is right for you. The Internet offers lots of information on clinical trials but only your health care team will know if there is a possible trial 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 can explain what participating in a clinical trial will involve and how it may affect your care and daily life.