Treatment for Prostate Cancer

Early detection and proper treatment may eliminate prostate cancer or prevent it from progressing, which can greatly reduce the risk of dying from the disease.

Like any form of treatment, prostate cancer treatment can pose physical, psychological and emotional challenges, and some treatments require extensive recovery time. The patient may also deal with relationship, sexual and other issues during the course of treatment and recovery.

Knowledge is power. The more a man and his partner learns about prostate cancer, the better equipped they are to handle the challenges of the disease.

The benefits of treatment of prostate cancer can be substantial. In the United States, 72 percent of men diagnosed with prostate cancer are still alive 10 years after diagnosis, and 53 percent survive 15 years.

As a result of new and improved developments in the treatment of prostate cancer, patients are living longer and with less discomfort and fewer treatment-related side effects.

There are many treatments for prostate cancer. The best treatment depends on several factors: the disease stage, the man's age and life expectancy, his doctor's recommendations and his own decisions.

Treatment options for early-stage prostate cancer include:
Radical prostatectomy is the surgical removal of the prostate. A radical prostatectomy may be performed to remove the cancer from the prostate and from nearby areas where the cancer has spread. This type of surgery may help prevent further spread of the cancer.

Prostatectomy may be used alone or in combination with hormonal therapy for the treatment of prostate cancer. It is most often used during early stages (Stages T1 and T2), when prostate cancer is located only within the prostate.

If the tumor is small and has not spread outside of the prostate, then surgery may optimally treat the disease. In some cases, it may be used to treat locally advanced disease (Stages T3 and T4). However, complete surgical removal of the prostate is not common when the cancer has spread to the lymph nodes or other sites.

After the prostate is removed, it is sent for evaluation. The margins or edges of the prostate are inspected. If the margins of the prostate do not have cancer cells (negative margins), it is assumed that the cancer was confined within the prostate and has not spread outside of the prostate. However, if the margins are found to contain cancer cells (positive margins), cancer may remain in the body and further treatment, such as radiation or hormonal therapy, may be necessary.

Radiation therapy is the use of high-energy, external x-ray beams or internal radiation seeds to kill prostate cancer cells, shrink tumors or prevent cancer cells from dividing and spreading. It is nearly impossible to direct these rays only at the cancer cells. As a result, they may damage both cancer cells and healthy cells nearby. Radiation doses are usually small and spread out over time. This allows the healthy cells to recover and survive, while the cancer cells eventually die.

Radiation therapy may be used when prostate cancer has not spread beyond the prostate (Stages T1-T2). Like prostatectomy, radiation therapy works best when the cancer is located in a small area, and it can help prevent the cancer from spreading further. In early stages of prostate cancer, radiation therapy may cure the disease.

Radiation therapy also may be used alone or in combination with hormonal therapy when cancer cells have spread beyond the prostate and into the pelvic area (Stages T3-T4). It may also be used for pain relief in prostate cancer that has spread to the bones (Stage M+) or that is no longer responding to hormonal therapy.

Watchful Waiting (also called Expectant Therapy). For some patients and certain stages of prostate cancer, the recommended treatment may simply be to “watch and wait,” at least in the short term. This means that the patient doesn’t receive any immediate therapy. The doctor monitors the cancer by performing routine DRE and PSA tests. The digital rectal exam (DRE) and the Prostate Specific Antigen (PSA) blood test are the two most common methods of detecting prostate cancer.

Watchful waiting may be used when prostate cancer is diagnosed at a very early stage or is not expected to progress quickly enough to begin using therapy. Watchful waiting may also be used if a patient is not expected to tolerate other therapy due to other adverse health conditions.

Treatment options for advanced prostate cancer include:
Hormonal therapy. The primary strategy of hormonal therapy is to decrease the production of testosterone by the testes or block the actions that testosterone has on the prostate cells. Hormonal therapy cannot cure prostate cancer. Instead, it slows the cancer's growth and reduces the size of the tumor(s).

Hormonal therapy is most commonly used to treat cancer that has spread (metastasized) outside the prostate and pelvic area (Stages N+ and M+).

In patients with early-stage cancer (Stage T1-T2), hormonal therapy may be used in combination with radiation therapy or prostatectomy. It may also be combined with radiation therapy or prostatectomy in advanced stages of cancer when the disease has spread locally beyond the prostate (Stages T3-T4).

Hormones may be given as medicines in the form of injections or pills.
Hormone treatment may also include surgical removal of the testicles (a procedure called orchiectomy), where 90-95 percent of the body's testosterone is produced. This prevents male hormones from further stimulating the growth of the prostate cancer.
In some cases, both surgery and medications are used.

Radiation therapy. The use of high-energy, external x-ray beams to destroy cancerous tissue.

Chemotherapy. In cancer treatment, chemotherapy refers to the use of drugs whose main effect is either to kill or slow the growth of rapidly multiplying cells. Chemotherapy usually includes a combination of drugs, since this is more effective than a single drug given alone.

Chemotherapy may be used in cases of advanced prostate cancer, but it is not commonly used to treat early stage disease.