There are many different ways to treat prostate cancer. The method (or methods) chosen is determined by how advanced the cancer is, whether it has spread outside the prostate, and the overall health of the patient.
Because prostate cancer grows very slowly, it is quite possible for a man with prostate cancer to live a full life without ever needing treatment or experiencing any symptoms. If a doctor believes the risks and side effects of other forms of treatment outweigh the benefits, he or she may recommend active surveillance, also called watchful waiting or expectant management. The cancer’s progress will be closely monitored via blood tests, biopsies, and other tests. If its growth remains slow and does not start to spread or cause symptoms, it will not be otherwise treated.
If cancer is confined to the prostate alone, one treatment option is radical prostatectomy (complete removal of the prostate gland), which can be done multiple ways:
- Open Surgery: a large incision is made in the abdomen or the perineum (the area between the rectum and the scrotum) to access the prostate.
- Laparoscopic Surgery: several specialized cameras and tools are used to see inside the body through small incisions.
- Robotic-assisted Laparoscopic Surgery: the surgeon controls very precise robotic arms to perform laparoscopic surgery.
Laparoscopic surgery is less invasive, but an advantage of open surgery is that it allows doctors to examine nearby lymph nodes and other tissues for evidence of cancer as well.
In this procedure, probes are inserted into the prostate and then filled with very cold gases to freeze and kill cancerous tissue.
Both radical prostatectomy and cryosurgery are most often done under general anesthesia—with the patient completely unconscious—or using epidural anesthesia, in which drugs are injected directly into the spine to numb a large area of the body.
Complications of Prostatectomy and Cryosurgery: Prostate produces fluid that supports the health of semen. Loss of the prostate will decrease the amount of fluid in male ejaculate. People who undergo prostatectomy may experience “dry orgasm” with no emission. However, sperm are still produced in the seminal vesicles provided only the prostate is removed. Sperm may be extracted from the vesicles and used for in vitro fertilization to produce an embryo for implantation. Other possible side effects of prostatectomy or cryosurgery are urinary incontinence and impotence. The nerves that affect the ability to control urine and get an erection are very close to the prostate, and they can be damaged during surgery.
Transurethral Resection of the Prostate (TURP)
During this surgical procedure, a long, thin scope with a cutting tool on the end is inserted into the urethra and used to cut away prostate tissue that is blocking the flow of urine. TURP cannot remove the entire prostate, but it can be used to relieve urinary symptoms in men with prostate cancer.
Radiation therapy kills cancer cells by exposing them to controlled doses of radioactivity. Radiation is often used instead of surgery in men with early-stage prostate cancer that has not spread to other parts of the body. It can also be used in combination with surgery to ensure that all cancerous tissue has been removed or, in advanced prostate cancer, to shrink tumors and reduce symptoms. There are two main forms of radiation therapy.
Radiation is delivered from outside the body during a series of treatment sessions. There are many different kinds of external radiation therapy that use different sources of radiation and different treatment methods. The goal is to target only the cancerous area and spare healthy tissue.
Internal Radiation (also called Brachytherapy)
Tiny packets of radioactive material called seeds are surgically implanted into the cancerous prostate tissue. The seeds give off radiation for several months, killing the cancer cells.
Radiation Therapy Side Effects: The most common side effects of all radiation therapy are fatigue and bowel or urinary problems like diarrhea and painful urination, as well as bleeding from damage done to tissues surrounding the prostate. Impotence is less common and is usually temporary. Internal radiation therapy can also cause temporary urinary incontinence.
Androgens (male hormones, such as testosterone) cause prostate tissue to grow. Therefore, reducing the body’s production of androgens can slow the growth and spread of prostate cancer or even shrink tumors. Hormone therapy is commonly used when prostate cancer has spread beyond the prostate, if radiation and/or surgery are not possible for a patient, or if prostate cancer recurs after being treated another way. Hormone therapy cannot cure prostate cancer, but it can significantly slow or reverse its progress.
A drug (or combination of drugs) that affects androgens in the body is the most common type of hormone therapy. The classes of drugs used in prostate-cancer hormone therapy include:
- Luteinizing hormone-releasing hormone (LHRH) analogs, LHRH agonists, and LHRH antagonists, which prevent the testicles from making testosterone.
- Antiandrogens, which block the action of androgens in the body.
- Other androgen-suppressing drugs, which prevent the adrenal glands from making testosterone (About 90 percent of testosterone is made in the testicles, but some also comes from the adrenal glands.)
Another hormone-therapy option is orchiectomy, the surgical removal of the testicles. Orchiectomy is permanent and irreversible, so drug therapy is much more common.
Possible side effects of hormone therapy include loss of sex drive, impotence, hot flashes, anemia, osteoporosis, weight gain, and fatigue.
Chemotherapy is the use of strong drugs to kill cancer cells. It is not a common treatment for prostate cancer, but it can be used if cancer has spread throughout the body and hormone therapy has been unsuccessful. Scientists are also studying the possibility that chemotherapy made reduce the recurrence of cancer if used immediately after prostate surgery. Chemotherapy drugs for prostate cancerare usually given intravenously (injected into a vein) and can be administered at home, at a doctor’s office, or in a hospital. Like hormone therapy, chemotherapy cannot cure prostate cancer, but it can shrink tumors, reduce symptoms, and prolong life.
Possible side effects of chemotherapy include fatigue, hair loss, loss of appetite, nausea, vomiting, diarrhea, and reduced immune system function.
Immunotherapy is one of the newest forms of cancer treatment. It uses the patient’s own immune system to fight tumor cells. In April 2010, the Food and Drug Administration (FDA) approved a new immunotherapy vaccine called Provenge to treat prostate cancer. Unlike other vaccines, Provenge does not prevent the disease but is used to treat advanced prostate cancer that has been resistant to androgen-reducing therapies. Samples of the patient’s white blood cells are exposed to protein that are present in prostate tissue. The white cells ‘remember’ the protein and are able to react to it and destroy cells that contain that protein. These white cells are then injected into the body and are able hone in on the tumor tissue and attack it. Provenge has been shown to improve survival from metastatic cancer by 4 months. Provenge is currently a new and expensive procedure, but it should be available to most patients that need it by early 2011.
High-Intensity Focused Ultrasound (HIFU)
High-intensity focused ultrasound (HIFU) is a new cancer treatment that’s currently being studied in the United States. It uses focused beams of high-frequency sound waves to heat up and kill cancer cells in a similar manner to radiation therapy but without using radioactive materials.