Various options for treating prostate cancer at different stages of the disease include:
- Watchful waiting
- Active surveillance
- Targeted therapy
- Hormone therapy1
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
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
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
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 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 uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells without harming normal cells.
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.
- National Comprehensive Cancer Network. NCCN Treatment Summaries for People with Cancer. Prostate Cancer – Overview http://nccn.com/prostate_cancer_overview.aspx. Accessed February 16, 2010
- Cancer Facts & Figures 2009. American Cancer Society.
- Prostate Cancer Foundation. FAQs About Prostate Cancer. http://prostatecancerfoundation.org/site/c.itIWK2OSG/b.4983495/k.5C76/About_Prostate_Cancer.htm. Accessed February 16, 2010.
- Zelefsky M, Eastham JA, Sartor O, Kantoff P. Cancer of the Prostate. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. Cancer Principles and Practice. 8th ed. Philadelphia, PA. Lippincott, Williams & Wilkins. 2008.
- SEER. http://seer.cancer.gov/statfacts/index.html. Accessed December 8, 2010.
- National Cancer Institute. Early Prostate Cancer. http://cancer.gov/cancertopics/factsheet/Detection/early-prostate. Accessed February 16, 2010.
- Report to the Nation on Prostate Cancer: A Guide for Men and their Families. Prostate Cancer Foundation. 2005. Santa Monica, CA.
- ACS Detailed Guide: Prostate Cancer. Hormone (androgen deprivation) Therapy. www.cancer.org. Accessed February 25, 2010.
- Prostate Cancer Foundation. Risk Factors. http://www.pcf.org/site/c.leJRIROrEpH/b.5802027/k.D271/Prostate_Cancer_Risk_Factors.htm Accessed February 16, 2010.
- ACS Detailed Guide: Prostate Cancer. How Is Prostate Cancer Staged? www.cancer.org. Accessed February 25, 2010.
- ACS Detailed Guide: How is Prostate Cancer Found? www.cancer.org. Accessed March 23, 2010.
- Prostate Cancer Basics. My Cleveland Clinic. http://myclevelandclinic.org/disorders/prostate_cancer/hic_prostate_cancer_basics.aspx. Accessed February 25, 2010.
- National Comprehensive Cancer Network. NCCN Treatment Summaries for People with Cancer. Prostate Cancer – Advanced. http://nccn.com/metastatic_prostate_cancer.aspx. Accessed February 18, 2010.
- Trelstar 3.75 mg, 11.25 mg, 22.5 mg [prescribing information]. Morristown, NJ: Watson Pharma, Inc.; 2010.
- ZERO The Project to End Prostate Cancer. http://zerocancer.org/site/PageServer?pagename=APC_Risk_Factors. Accessed February 16, 2010.
- National Comprehensive Cancer Network. NCCN Treatment Summaries for People with Cancer. Prostate Cancer–Localized. http://nccn.com/metastatic_prostate_cancer.aspx. Accessed February 24, 2010.
- Netter FH. Atlas of Human Anatomy. East Hanover, NJ: Novartis; 1997. Plate 338.
- ACS Detailed Guide: Prostate Cancer. How is Prostate Cancer Diagnosed? www.cancer.org. Accessed February 25, 2010.
- ACS Detailed Guide: Prostate Cancer. Expectant Management (watchful waiting) and active surveillance. www.cancer.org. Accessed February 25, 2010.
- ACS Detailed Guide: Prostate Cancer. Surgery. www.cancer.org. Accessed February 25, 2010.
- ACS Detailed Guide: How is Prostate Cancer Treated?. www.cancer.org. Accessed March 23, 2010
- ACS Detailed Guide: Prostate Cancer. Radiation Therapy. www.cancer.org. Accessed February 25, 2010.
- Firmagon full Prescribing Information. Ferring Pharmaceuticals. 2009.
- MedicineNet. Medical Dictionary. http://medterms.com. Accessed March 23, 2010.
- National Cancer Institute. U. S. National Institutes of Health. NCI Dictionary of Cancer Terms. http://cancer.gov/dictionary. Accessed March 25, 2010.
- The Free Dictionary. Medical Dictionary. http://thefreedictionary.com. Accessed March 23, 2010.
- Data on file. CSR DEB-TRI6M-301. Watson Pharma, Inc.
Trelstar® is indicated for the palliative treatment of advanced prostate cancer.
Important Safety Information
After your first injection of Trelstar®, you might feel a temporary increase in your cancer symptoms, such as pain in your bones, nerve disorder, blood in your urine, blockage in the canals leaving your bladder, or pressure in the spinal cord that may lead to weakness or paralysis with or without fatal complications. This is because the amount of testosterone in your bloodstream actually goes up for a short period after the injection. If your symptoms increase later than the first week or two following an injection, tell your doctor. The most common side effects that patients taking Trelstar® have are actually the effect of lowering testosterone levels. The most common effect of lowering testosterone is hot flushes or flashes. These are like the hot flashes women have around the time of menopause. Other side effects include bone pain, impotence (sexual side effect), tissue breakdown in the testicles, headache, leg pain, and swelling in the legs. Women who are or may become pregnant and those who are allergic to this type of drug should not take Trelstar®. A severe potentially fatal form of shock, hyper allergic response, and allergic swelling related to Trelstar® have been reported. For more information on these and other side effects, please talk to your doctor.