Treatment Options

Various options for treating prostate cancer at different stages of the disease include:

• Watchful waiting
• Active surveillance
• Surgery
• Radiation
• Chemotherapy
• Targeted therapy
• Hormone therapy1

Watchful Waiting

The doctor closely monitors the patient’s condition. No treatment is given until symptoms appear or change. Watchful waiting is usually the approach used in older men with an early stage of the disease who suffer from other medical problems.19

Active Surveillance

The doctor delays therapy until the threat posed by the cancer can be more accurately assessed. This approach is an attempt to avoid overtreatment in the majority of patients, but administer curative therapy to selected patients. Patients are examined regularly in order to detect cancer progression while a cure is still possible.4

Surgery19

Patients younger than age 70 may be offered surgery (radical prostatectomy, in which the prostate is removed along with surrounding tissue and lymph nodes. Types of this surgery include:

• Open/traditional surgery. An incision is made through the lower abdomen or through the perineum (between the rectum and scrotum). The prostate and any nearby tissue where cancer may have spread are removed
• Laparoscopic surgery. Tiny incisions are made in the abdomen, and a laparoscope (a long tube-like camera) pictures the area while long instruments remove the prostate and affected tissues. These smaller incisions allow healing to occur more quickly, but a risk of incomplete tumor removal remains
• Robotic nerve-sparing surgery. The surgeon uses a system made up of a laparoscope and two or three robotic arms, which can perform very precise movements. This causes less damage to surrounding tissue. It also may help spare nerves that control erections20
• Cryosurgery. The surgeon uses cold metal probes through which cold gases are passed to freeze prostate cells and destroy the prostate gland. This procedure is used only for prostate cancer than has not spread.21

Urinary or fecal incontinence are possible side effects of surgery, as is impotence.

Radiation22

This treatment uses high-energy x-rays or other kinds of radiation to destroy cancer cells. Two types of radiation therapy are offered:

• External beam radiation therapy. Done on an outpatient basis, a machine is used outside the body to direct radiation toward the cancer spots. Used for locally advanced prostate cancer, it can be given in combination with hormone therapy for advanced cancer not spread to a distant organ13
• IMRT: Intensity-modulated radiation therapy allows clinicians to change the intensity of the doses and radiation beams to better target the radiation delivered to the prostate. Lower doses are delivered to the tumor cells that are immediately adjacent to the bladder and rectal tissue, thereby lowering side effects while keeping cure rates as high as possible.7
• Brachytherapy. Tiny radioactive seeds are implanted inside or near the tumor during an outpatient visit. It is recommended for men with only a small risk of recurrence16

Urinary incontinence and impotence may occur.

Chemotherapy

Chemotherapy uses chemicals or drugs that seek and destroy cancer cells. Normal cells may also be damaged. Chemotherapy can be given intravenously or orally with a pill.

Targeted Therapy

Targeted therapy uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells without harming normal cells.

Hormone Therapy

Most prostate cancer cells thrive on male hormones such as testosterone for their growth. Hormone therapy minimizes hormone levels or blocks their action to keep cancer cells from growing.