Prostate Cancer Treatments

Active surveillance

Prostate cancer usually grows very slowly. This means that you can live a full life without ever needing treatment or experiencing symptoms. If your doctor believes the risks and side effects of treatment outweigh the benefits, they may recommend active surveillance. This is also called watchful waiting or expectant management.

Your doctor will closely monitor the cancer’s progress with blood tests, biopsies, and other tests. If its growth remains slow and doesn’t spread or cause symptoms, it won’t be treated.

Surgery

Surgical treatments for prostate cancer include the following:

Radical prostatectomy

If cancer is confined to the prostate, one treatment option is radical prostatectomy. During this procedure, the prostate gland is completely removed. This can be performed in several ways:

• Open
  surgery: The
  surgeon makes a large incision in the lower abdomen or perineum to access the
  prostate. The perineum is the area between the rectum and the scrotum.
• Laparoscopic
  surgery: The
  surgeon uses several specialized cameras and tools to see inside the body and
  remove the prostate gland through small incisions.
• Robotic-assisted
  laparoscopic surgery:
  The surgeon controls very precise robotic arms from a computerized control
  panel to perform laparoscopic surgery.

Laparoscopic surgery is less invasive, as the incisions are smaller. Either laparoscopic or open surgery allows doctors to also examine nearby lymph nodes and other tissues for evidence of cancer.

Loss of the prostate will decrease the amount of fluid in male ejaculate. Men who undergo prostatectomy may experience “dry orgasm” with no emission, as the seminal vesicles that produce a large amount of the fluid of semen are removed during a radical prostatectomy. However, sperm are still produced in the seminiferous tubules within the testes.

Cryosurgery

In this procedure, your doctor will insert probes into the prostate. The probes are then filled with very cold gases to freeze and kill cancerous tissue.

Both cryosurgery and radical prostatectomy are usually done under general anesthesia or regional anesthesia (spinal or epidural anesthesia). General anesthesia puts you completely to sleep during the surgery. Regional anesthesia numbs an area of your body with drugs injected into the spinal canal or epidural space.

Possible side effects of cryosurgery and prostatectomy are urinary incontinence and impotence. The nerves that affect the ability to control urine and get an erection are close to the prostate. These nerves can be damaged during surgery.

Transurethral resection of the prostate (TURP)

During this surgical procedure, your doctor will insert a long, thin scope with a cutting tool on the end into the penis through the urethra. They will use this tool to cut away prostate tissue that’s blocking the flow of urine. TURP can’t remove the entire prostate. So it can be used to relieve urinary symptoms in men with prostate cancer, just not for trying to cure the cancer.

Radiation therapy

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 hasn’t spread to other parts of the body. Doctors can also use radiation in combination with surgery. This helps ensure all cancerous tissue has been removed. In advanced prostate cancer, radiation can help shrink tumors and reduce symptoms.

There are two main forms of radiation therapy:

External radiation

External beam radiation therapy (EBRT) is delivered from outside the body during a series of treatment sessions. There are many different kinds of EBRT therapy. They may use different sources of radiation or different treatment methods.

Examples include intensity modulated radiation therapy (IMRT), which is the most common EBRT for treating prostate cancer, and proton beam radiation therapy.

The latter is less widely available and typically associated with a higher cost. With either type, the goal is to target only the cancerous area and spare adjacent healthy tissue as much as possible.

Internal radiation (also called brachytherapy)

Internal radiation involves surgically implanting radioactive material into the cancerous prostate tissue.

It can be short-term and administered through a catheter, with a high-dose over a few treatments lasting a couple days each. The radioactive media is then removed. Or it can be delivered via implantable pellets (also called seeds) of radioactive material that are permanently left in. These seeds give off radiation for several weeks or months, killing the cancer cells.

The most common side effects of all radiation therapy are bowel and urinary problems like diarrhea and frequent or painful urination. Damage to the tissues surrounding the prostate can also cause bleeding.

Impotence is less common than these, but still a potential side effect, and may be only temporary.

Fatigue is another potential side effect, as is urinary incontinence.

Hormone therapy

Androgens, such as the main male hormone testosterone, cause prostate tissue to grow. 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
• radiation
  or surgery aren’t possible
• prostate
  cancer recurs after being treated another way

Hormone therapy alone can’t cure prostate cancer. But it can significantly slow or help to reverse its progress.

The most common type of hormone therapy is a drug or combination of drugs that affects androgens in the body. The classes of drugs used in prostate cancer hormone therapy include:

• Luteinizing hormone-releasing hormone
  (LHRH) analogs,
  which prevent the testicles from making testosterone. They are also called
  LHRH agonists and GnRH agonists.
• LHRH antagonists are another class of
  medication that prevents testosterone production in the testicles.
• Antiandrogens block the action of androgens in the body.
• Other androgen-suppressing drugs (such
  as estrogen) prevent
  the testicles from making testosterone.

Another hormone therapy option is the surgical removal of the testicles, called orchiectomy. This procedure 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
• fatigue

Chemotherapy

Chemotherapy is the use of strong drugs to kill cancer cells. It’s not a common treatment for earlier stages of prostate cancer. However, it can be used if cancer has spread throughout the body and hormone therapy has been unsuccessful.

Chemotherapy drugs for prostate cancer are usually given intravenously. They can be administered at home, at a doctor’s office, or in a hospital. Like hormone therapy, chemotherapy typically can’t cure prostate cancer at this stage. Rather, it can shrink tumors, reduce symptoms, and prolong life.

Possible side effects of chemotherapy include:

• fatigue
• hair loss
• loss of appetite
• nausea
• vomiting
• diarrhea
• reduced immune system
  function

Immunotherapy

Immunotherapy is one of the newer forms of cancer treatment. It uses your own immune system to fight tumor cells. Certain immune system cells, called antigen-presenting cells (APCs), are sampled in a laboratory and exposed to a protein that is present in most prostate cancer cells.

These cells remember the protein and are able to react to it and help the immune system’s T-lymphocyte white blood cells know to destroy cells that contain that protein. This mixture is then injected into the body, where it targets the tumor tissue and stimulates the immune system to attack it. This is called the Sipuleucel-T vaccine.

High-intensity focused ultrasound (HIFU)

High-intensity focused ultrasound (HIFU) is a new cancer treatment that’s being studied in the United States. It uses focused beams of high-frequency sound waves to heat up and kill cancer cells. This method is similar to radiation therapy in that it aims at the focus of the cancer tumor, but doesn’t use radioactive materials.

The bottom line

Your doctor and healthcare team will help you determine which of these prostate cancer treatments is right for you. Factors include the stage of your cancer, the extent of the cancer, the risk of recurrence, as well as your age and overall health.