Prostate cancer - treatment
Treatment for your prostate cancer is chosen after a thorough evaluation. Your health care provider will discuss the benefits and risks of each treatment.
Sometimes your provider may recommend one treatment for you because of your type of cancer and risk factors. Other times, there may be two or more treatments that could be good for you.
Factors you and your provider must think about include:
- Your age and other medical problems you may have
- Side effects that occur with each type of treatment
- Whether the prostate cancer is localized or how much the prostate cancer has spread
- Your Gleason score, which tells how aggressive the cancer is
- Your prostate-specific antigen (PSA) test result
Ask your provider to explain these things following about your treatment choices:
- Which choices offer the best chance of curing your cancer or controlling its spread?
- How likely is it that you will have different side effects, and how they will affect your life?
As men get older, they have a lot of new worries to deal with, from hair loss, weight gain, perhaps even erectile dysfunction. In addition, cancer is one of the biggest concerns that older men face, especially prostate cancer, which is the leading cause of cancer death in men over 75. Younger men may not be very familiar with their prostate, the walnut-shaped gland that wraps around the urethra, the tube that carries urine out of the body. But as they get older, the prostate can start to cause problems. Men over the age of 60 are at increased risk for prostate cancer, especially if they're of African descent, they have a father or brother with the disease, or they eat a lot of burgers and processed meats in their daily diet. It can be hard to pinpoint prostate cancer symptoms, because they usually start late in the disease and they can mimic symptoms of a benign, enlarged prostate, which is also more common in older men. Symptoms like a slow urine stream, dribbling, blood in the urine, or straining while urinating can be signs of either condition. An enlarged prostate can also confuse the results of a PSA test, which is used to screen for prostate cancer. So, if your doctor thinks you might have prostate cancer, you may need a biopsy, which is a procedure that removes a small piece of prostate tissue and sends it to the lab to check for cancer. Then a scoring system called the Gleason grade is used to tell how fast your cancer might spread. Your Gleason grade will help decide what treatment you get. Early-stage prostate cancers that haven't spread are often removed with surgery, and then treated with radiation therapy to kill any remaining cancer cells. Prostate cancer surgery may affect your ability to have sex and control urine, so talk about these issues with your doctor before you have the procedure. Because prostate cancer tends to grow very slowly, your doctor may want to just monitor you with PSA tests and biopsies, and avoid treatment unless the cancer starts to spread. Prostate cancer that has spread is usually treated with surgery, chemotherapy, or hormone therapy. If your doctor discovers prostate cancer in its early stages, before it spreads, it's pretty easy to treat, and even cure. Treatments can also slow down prostate cancer that's spread, and extend your survival. Before you have to deal with a prostate cancer diagnosis, ask your doctor for ways to prevent and screen for the disease. Eating a healthy, low-fat diet that's high in healthy omega-3 fatty acids might help lower your risk. There are also drugs called finasteride and dutasteride that are used in some men to prevent prostate cancer. Talk with your doctor about the pros and cons of these drugs, as well as the possible benefits and risks of having your PSA levels tested.
Radical Prostatectomy (Prostate Removal)
Radical prostatectomy is a surgery to remove the prostate and some of the surrounding tissue. It is an option when the cancer has not spread beyond the prostate gland.
Healthy men who will likely live 10 or more years after being diagnosed with prostate cancer often have this procedure.
Be aware that it is not always possible to know for certain, before surgery, if the cancer has spread beyond the prostate gland.
Possible problems after surgery include difficulty controlling urine and erection problems. Also, some men need further treatments after this surgery.
Radiation therapy works best for treating prostate cancer that has not spread outside of the prostate. It may also be used after surgery if there is a risk that cancer cells are still present. Radiation is sometimes used for pain relief when cancer has spread to the bone.
External beam radiation therapy uses high-powered x-rays pointed at the prostate gland:
- Before treatment, the radiation therapist uses a special pen to mark the part of the body that is to be treated.
- Radiation is delivered to the prostate gland using a machine similar to a regular x-ray machine. The treatment itself is usually painless.
- Treatment is done in a radiation oncology center that is usually connected to a hospital.
- Treatment is usually done 5 days a week for 6 to 8 weeks.
Side effects may include:
- Appetite loss
- Erection problems
- Rectal burning or injury
- Skin reactions
- Urinary incontinence, the feeling of needing to urinate urgently, or blood in the urine
There are reports of secondary cancers arising from the radiation as well.
Proton therapy is another kind of radiation therapy used to treat prostate cancer. Proton beams target the tumor precisely, so there is less damage to the surrounding tissue. This therapy is not widely accepted or used.
Brachytherapy is often used for small prostate cancers that are found early and are slow-growing. Brachytherapy may be combined with external beam radiation therapy for more advanced cancers.
Brachytherapy involves placing radioactive seeds inside the prostate gland.
- A surgeon inserts small needles through the skin beneath your scrotum to inject the seeds. The seeds are so small that you do not feel them.
- The seeds are left in place permanently.
Side effects may include:
- Pain, swelling, or bruising in the penis or scrotum
- Red-brown urine or semen
- Urinary retention
Testosterone is the main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is treatment that decreases the effect of testosterone on prostate cancer.
Hormone therapy is mainly used for cancer that has spread beyond the prostate, but it can also be used along with surgery and radiation to treat advanced cancers. The treatment can help relieve symptoms and prevent further growth and spread of cancer. But it does not cure the cancer.
The main type of hormone therapy is called a luteinizing hormone-releasing hormones (LH-RH) agonist. Another class of therapy is called LH-RH antagonists:
- Both types of medicines block the testicles from making testosterone. The drugs must be given by injection, usually every 3 to 6 months.
- Possible side effects include nausea and vomiting, hot flashes, breast growth and/or tenderness, anemia, fatigue, thinning bones (osteoporosis), reduced sexual desire, decreased muscle mass, weight gain, and impotence.
The other type of hormone medicine is called an androgen-blocking drug:
- It is often given along with LH-RH drugs to block the effect of testosterone produced by the adrenal glands, which make a small amount of testosterone.
- Possible side effects include erection problems, reduced sexual desire, liver problems, diarrhea, and enlarged breasts.
Much of the body's testosterone is made by the testes. As a result, surgery to remove the testes (called orchiectomy) can also be used as a hormonal treatment.
Cryotherapy uses very cold temperatures to freeze and kill prostate cancer cells. The goal of cryosurgery is to destroy the entire prostate gland and possibly surrounding tissue.
Cryosurgery is generally not used as a first treatment for prostate cancer.
National Cancer Institute website. Prostate cancer treatment (PDQ) - health professional version.
National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): prostate cancer. Version 1.2020.
Nelson WG, Antonarakis ES, Carter HB, De Marzo AM, DeWeese TL. Prostate cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier Saunders; 2020:chap 81.
Last reviewed on: 9/23/2019
Reviewed by: Sovrin M. Shah, MD, Assistant Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.