Prostate Cancer Treatments

Watchful waiting involves no medication. Instead, your doctor tests periodically to see if the cancer is growing. Watchful waiting is suggested for:

• Early stage prostate cancer that seems to be growing slowly
• Older prostate cancer patients or those with serious medical problems that may make the risks of treatment outweigh the possible benefits

Surgery for prostate cancer involves the removal of the cancerous tumor and nearby tissues, and possibly nearby lymph nodes. Surgery is generally offered to patients who are in good health and are younger than 70 years old. Types of surgery include:

• Pelvic Lymphadenectomy—removal of lymph nodes in the pelvis to determine if they contain cancer; if they do, removal of the prostate and other treatment may be recommended
• Radical Retropubic Prostatectomy—removal of the entire prostate and nearby lymph nodes through an incision in the abdomen
• Radical Perineal Prostatectomy—removal of the entire prostate through an incision between the scrotum and the anus; nearby lymph nodes are sometimes removed through a separate incision in the abdomen
• Transurethral Resection of the Prostate (TURP)—removal of part of the prostate with an instrument inserted through the urethra; a TURP is not a cancer surgery, but can be used to relieve the symptoms of obstruction when a patient has either prostate cancer or an enlarged gland due to other reasons

Possible side effects of surgery include impotence and leakage of urine from the bladder or stool from the rectum.

In addition to traditional surgery, robotic surgery and laparascopic surgery may be options in your community. These minimally invasive techniques can help reduce side effects, blood loss, and recovery time over traditional "open" surgery.

Radiation therapy, also known as radiotherapy, involves the use of radiation to kill cancer cells and shrink tumors. Radiation therapy may be:

• External Radiation Therapy—radiation directed at the tumor from a source outside the body
• Internal Radiation Therapy—dozens of tiny radioactive seeds are implanted directly into the prostate gland using needles; the seeds remain in the prostate gland permanently and harmlessly; this method delivers radiation directly to the affected area, and reduces the risk of damage to surrounding areas such as the rectum and bladder; internal radiation therapy is most often used for treating earlier stage cancers

Possible side effects of radiation therapy include impotence and urinary problems.

Hormone therapy is often used for patients whose prostate cancer has spread beyond the prostate or has recurred after treatment. The goal of hormone therapy is to lower levels of the male hormones, also known as androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancers to shrink or grow more slowly, but does not cure cancer. Methods of hormone therapy include:

• Orchiectomy—a surgical procedure to remove one or both of the testicles, which are the main source of male hormones; orchiectomy decreases hormone production, which can shrink or slow the growth of most prostate cancers
• Luteinizing Hormone-releasing Hormone (LHRH) Agonists—injections that can decrease the amount of testosterone produced by the testicles
• Antiandrogens (eg, flutamide, bicalutamide)—medications that can block the action of androgens; these medications are often used in combination with orchiectomy or LHRH agonists, a combination called total androgen blockade
• Drugs That Prevent Adrenal Glands From Producing Androgens (eg, ketoconazole, aminoglutethimide)
• Estrogens—drugs that can prevent the production of testosterone in the testicles; estrogens are rarely used today because of the risk of serious side effects

Possible side effects of hormone therapy include hot flashes, impaired sexual function, loss of sexual desire, and weakened bones.

In addition to standard treatments, other treatments are being investigated in clinical trials. Patients may want to consider taking part in a clinical trial when weighing treatment options. The treatments that are currently being tested include:

• Cryosurgery uses an instrument to freeze and destroy prostate cancer cells.
• Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms, including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body, killing mostly cancer cells, but also some healthy cells. Since chemotherapy in the treatment of prostate cancer is still being investigated, it is not clear whether it can prolong survival in men with prostate cancer.
• Biological therapy is the use of medications or substances made by the body to increase or restore the body's natural defenses against cancer. It is also called biological response modifier (BRM) therapy. This treatment uses an endorectal probe that produces ultrasound (high-energy sound waves), which can destroy cancer cells.
• Conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
• IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.

Remember: Early detection is crucial in the fight against prostate cancer. If you have any of the following symptoms do not hesitate to consult your doctor. The sooner you are diagnosed, the better your chances of beating it become.

• The need to urinate frequently, especially at night
• Difficulty initiating urination or holding back urine
• Weak urine flow
• Interrupted flow of urine
• A burning sensation when urinating
• Difficulty achieving an erection
• Painful ejaculation
• The presence of blood in urine or semen
• Persistent pain or stiffness in the lower back, hips, or upper thighs