Treatment Options

For some patients with prostate cancer, a “watch and wait” approach may be recommended. The cancer is carefully observed and monitored with no specific treatment given unless the prostate cancer begins to show signs of advancing or causes symptoms. Physicians sometimes recommend this option for older patients who have early prostate cancer that is confined to one area of the prostate and is not causing any symptoms or other problems. Because prostate cancer cells often spread very slowly, many older men who have the disease may never need active treatment.

 

For many patients with prostate cancer, surgery may be recommended to remove the tumor. Several types of operations are currently done:

• Radical prostatectomy (Surgical removal of the prostate gland) is used to treat cancer that is confined to the prostate. During the operation, the entire prostate gland, along with some tissue around it, is removed.
• Transurethral resection is an operation that surgically removes part of the prostate gland using a tool with a small wire loop on the end. The tool is inserted through the urethra up to the prostate gland. The procedure is used for men who, because of age or other illness, cannot have a radical prostatectomy to relieve urinary obstructions caused by the tumor.
• Cryosurgery is a promising new surgical technique that is currently being evaluated for its effectiveness as a treatment for prostate cancer. This surgery involves inserting a metal probe directly into the tumor tissue and destroying the tumor by freezing.

Radiation therapy is another way to treat prostate cancer. In this treatment, high energy x-rays kill or shrink cancer cells. Radiation therapy is used to treat prostate cancer that is still confined to the prostate gland or has spread only to nearby tissue.

The goal of radiation is to destroy cancer cells by decreasing their ability to divide. If the disease is advanced, radiation may be used to reduce the size of the tumor and provide relief from symptoms. Radiation therapy usually eliminates the need for surgery.

Two types of radiation therapy are used to treat prostate cancer:

External beam radiation is much like getting an x-ray, but for a longer time. It is usually performed in an outpatient center. For external radiation therapy, one treatment per day will likely be given on 5 days each week over a period of 6 or 7 weeks. Each treatment lasts only a few minutes.

Internal radiation therapy uses small radioactive pellets (each about the size of a grain of rice) that are implanted directly into the cancerous cells of the prostate. This procedure is known as brachytherapy. These pellets, sometimes called seeds, give off small amounts of radiation for weeks or months. Because the pellets used for internal radiation therapy are so small, their presence causes no discomfort, and they are simply left in place.

This treatment is often used for patients whose prostate cancer has metastasized (spread to other parts of the body) or has recurred after treatment. Most evidence shows that hormone therapy works better if it is started as early as possible after the cancer has reached an advanced stage. The goal of hormone therapy is to lower levels of the male hormone, testosterone.

Testosterone is produced mainly in the testicles and causes prostate cancer cells to grow. Reduced testosterone levels can make the prostate cancer shrink or grow slower. However, hormone therapy does not cure the cancer. There are several methods used for hormone therapy:

Orchiectomy

This procedure involves surgical removal of the testicles. It is considered a routine operation which causes few complications.

Luteinizing Hormone-Releasing Hormone (LHRH) analogs

These drugs decrease the amount of testosterone produced by a man’s body. LHRH analogs are injected monthly or every three months at the physician’s office or at the oncology center. Research shows that these drugs can lower the level of testosterone as effectively as surgical removal of the testicles.

Anti-androgens

Recent studies have shown that even after orchiectomy, a small amount of testosterone is still produced in the body by the adrenal glands, Anti­androgens block the body’s ability to use testosterone. Anti-androgens are usually used in combination with orchiectomy or LHRH analogs.

Chemotherapy

Chemotherapy uses powerful anti-cancer drugs that are given to patients either intravenously (injected into a vein) or by mouth. It can be done in a doctor’s office, an outpatient clinic, or even at home in some cases.

Although not commonly used to treat prostate cancer, chemotherapy may be used for patients whose prostate cancer has spread outside of the prostate gland and for whom hormone therapy has failed. It has shown only limited success in treating advanced disease, but it may slow tumor growth and reduce pain. Chemotherapy is not recommended for the treatment of early prostate cancer.

Watchful Waiting.

The average age of men diagnosed with prostate cancer is 72 years, so many patients with prostate cancer, especially those whose disease is confined to the prostate gland, may die of other illnesses or old age without ever having suffered significant disability from their cancer.

Survival rates for all stages of prostate cancer have steadily improved over the past 50 years. This means that today, more than three-quarters of men who have prostate cancer can expect to live at least five years from the time the cancer was diagnosed. For men with prostate cancer that has not spread beyond the prostate gland, the 5-year survival rate climbs to 99%.