There are a variety of different options for treating prostate cancer and improving your prostate cancer survival rate. You and your doctor will decide which treatment regimen (or combination of regimens) is best for you, based on your age, overall health, and stage of your prostate cancer.
Given the slow growth of many prostate cancers, some patients and doctors will opt to monitor the cancer with regular PSA test, Digital Rectal Exams (DREs), and transrectal ultrasounds instead of initiating treatment. Follow-up biopsies may be performed to monitor the cancer’s growth as well. This course of action is typically not taken for young, healthy men or for men whose cancer has an advanced Gleason score and stage.
Surgery is often performed for prostate cancer, particularly if the cancer is limited to the prostate gland. Surgical removal of the prostate gland and surrounding tissue is called a radical prostatectomy and can be performed several different ways.
- Radical retropubic prostatectomy: In this procedure, the surgeon makes an incision in the lower abdomen and removes the prostate gland directly.
- Radical perineal prostatectomy: The prostate gland is removed through an incision between the anus and scrotum in this type of prostatectomy.
- Laparoscopic radical prostatectomy (LRP): The surgeon makes several small incisions in the abdomen through which they insert special equipment used to remove the prostate in LRPs. This type of prostatectomy usually results in a quicker recovery than a retropubic or perineal prostatectomy.
- Robotic-assisted laparoscopic radical prostatectomy (RALRP): This type of procedure is very similar to LRP except that the surgeon is controlling robotic tools to remove the prostate.
In addition to the normal risks of surgery, there are a number of potential side effects from prostate surgery that can occur because of its location, including erectile dysfunction symptoms. The nerves that control erection and bladder function are very near the prostate gland and can be damaged during a prostatectomy, leading to erectile dysfunction and/or urinary incontinence.
Additionally, the connections between the testes and the urethra are severed during a prostatectomy, resulting in infertility. The type of procedure performed does not appear to have a significant impact on the risk of side effects; however, depending on the nature of your cancer, your doctor may be able to take a nerve-sparing approach that results in fewer side effects.
Your doctor will discuss these possibilities with you prior to surgery and help you determine the type of procedure best suited for you.
There are two types of radiation therapy that your doctor may opt to use for your prostate cancer.
- External radiation: Often called external beam radiation or EBRT, this type of radiation involves having high-energy rays directed from a machine to the targeted area. This is typically used for early-stage cancers or as a means of reducing bone pain in metastatic prostate cancer. Traditional EBRT was often associated with a number of side effects resulting from damage to tissues near the prostate, including intestinal, bladder, and erectile problems. Several newer types of EBRT have been developed in an effort to minimize these side effects and achieve greater success with treatment: 3-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), conformal proton beam radiation therapy, and stereotactic body radiation therapy (SBRT).
- Internal radiation: Also called brachytherapy, involves placing radioactive material inside the prostate. This allows for delivery of radiation to the prostate with less exposure of the surrounding tissues and, thus, fewer side effects. Low-dose brachytherapy involves placing small radioactive particles into the prostate that are left in permanently. Their radioactivity wanes over time, ultimately disappearing. High-dose brachytherapy involves the temporary placement (usually for less than 15 minutes) of radioactive sources into the prostate for high dose radiation delivery. This is usually done several times over the course of several days.
Cryotherapy involves freezing the prostate tissue to kill the cancer cells. Small incisions are made between the anus and scrotum to insert the probes that deliver the cold gas. Cryotherapy is sometimes used in men with recurrent prostate cancer, in men who do not respond to radiation, or in men wishing to avoid the risk of side effects from surgery. Cryotherapy for prostate cancer has been in use only since the 1990s, so there is a paucity of long-term data on it.
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
These are medications used to lower testosterone levels in the blood by affecting testicular production of testosterone. Often when first administered they will cause a brief surge or flare in testosterone levels that can cause bone pain in men with cancer that has metastasized to the bone. Examples are leuprolide and histrelin.
Luteinizing Hormone-Releasing Hormone (LHRH) Antagonists
LHRH antagonists lower testosterone levels as well but tend to do so more quickly and without the initial testosterone surge seen with LHRH analogs.
Androgens are produced by the testes and the adrenal glands. This drug works by interfering with androgen production in the adrenal glands as well. It is often used in combination with LHRH analogs or antagonists and prednisone.
These drugs block androgens’ ability to affect prostate cells and are often used with LHRH analogs or antagonists. A newer type of anti-androgen is enzalutamide which specifically impedes the growth effect androgens have on prostate cells.
Male hormones called androgens cause prostate cancer cells to grow. While not curative, interfering with the hormones’ action on prostate cells can be an effective means of slowing tumor growth. Hormone therapy is often used in men who are not candidates for surgery or radiation, in men with recurrent cancer, in men at high risk of recurrence, or as an adjuvant to radiation in some men. There are a number of different medications that can be used in hormone therapy.
Side Effects: Hormone Therapy
Hormone therapy may result in a number of side effects ranging from weight gain to loss of sexual desire to an increased risk of heart disease and diabetes. Your doctor will discuss these with you prior to initiating therapy and may be able to adjust your dosing schedule to reduce these side effects. Exercise is often encouraged as a means of minimizing these effects.
Chemotherapy is sometimes used for prostate cancers that have spread outside the prostate gland, particularly if they are not responding to hormone therapy. However, chemotherapy is not curative for prostate cancer.
There are two main chemotherapy drugs used in treating prostate cancer. Each is given along with the steroid prednisone.
- Docetaxel: This is usually the first choice for chemotherapy treatment.
- Cabazitaxel: If docetaxel is not effective, this drug may be used.
As of 2010, a vaccine treatment for prostate cancer (Sipuleucel-T) has been available for some men whose cancer has spread outside the prostate gland. The treatment could affect prostate cancer survival rates; it involves taking white blood cells from the patient, exposing them to a protein on prostate cancer cells in a lab, and then readministering the cells to the patient. The vaccine then triggers the patient’s immune system to attack the cancer cells and has been shown to increase survival by four months in some men.
Originally published in March 2016 and updated.
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