What Are My Treatment Options?

While prostate cancer is very treatable, it can be life threatening. Therefore, any treatment decisions should be made through consultation with physician specialists such as urologists, radiation oncologists, and medical oncologists. Patients and their physicians can choose among several treatment options that may be used alone or in combination. All treatments can affect quality of life in different ways and to different degrees, and all carry the risk of impotency:

Active Surveillance
Prostatectomy
Hot and Cold Treatments
Hormone Therapy and Chemotherapy
Radiation Therapy
Intensity-Modulated Radiation Therapy (IMRT)

Active Surveillance

Since some prostate cancers may never produce symptoms or affect longevity, watchful waiting is an option for some men who prefer to avoid the potential side effects of cancer treatment. These patients undergo PSA tests and digital rectal exams every six months and prostate biopsies yearly to determine whether growing tumors warrant treatment.

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Prostatectomy

Men with early stage, localized prostate cancer often undergo surgical removal of all or parts of their prostate glands. Surgeons use a variety of techniques to perform prostatectomies. Some methods are less invasive than others, and some may spare the nerves that control erections. If you are considering prostatectomy, discuss the risks and benefits of these different approaches with your physician.

Patients typically spend two to three days in the hospital. A urinary catheter is placed during surgery and removed two to three weeks later, and total recuperation can take up to twelve weeks.

As with any major surgery, prostatectomy carries risks associated with anesthesia and incisions, including vascular complications, blood loss, infections, and death. The most common side effects include impotence and incontinence.

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Hot and Cold Treatments

Additional therapies kill prostate cancer cells by freezing or burning them, but these approaches are less frequently used since less is known about their long-term outcomes.

Cryosurgery

Also called cryoablation, this treatment delivers cold gasses through probes to freeze prostate cells. These probes are inserted through incisions between the anus and scrotum. The procedure requires a brief hospital stay and use of a urinary catheter for a couple of weeks. Immediately after the procedure, patients may experience swelling, bruising, soreness, and some blood in the urine.

While cryosurgery is less invasive than prostatectomy, freezing temperatures can damage the nerves, bladder, and intestines. Impotence and incontinence are more common after cryosurgery than prostatectomy.

High-Intensity Focused Ultrasound (HIFU)

By contrast, HIFU destroys cancer cells by heating them. This outpatient procedure involves inserting a probe into the anus to deliver the ultrasound waves. As with other treatments, a catheter is required for a few weeks. Prostate shrinkage can take up to three months, and improvements in the urinary stream also can take several months. Primary side effects include urinary obstruction and sloughing of prostate tissue in urine.

While HIFU has been used in Europe for several years, it has not yet been approved by the U.S. Food and Drug Administration.

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Hormone Therapy and Chemotherapy

Neither of these treatments can cure prostate cancer, but they may impede tumor growth and lessen symptoms. They may be used to treat cancer that has spread, or metastasized, to other part of the body, or they may be used as palliative treatments to reduce pain. However, their unpleasant side effects can significantly affect quality of life.

Hormone Therapy (Androgen Deprivation)

Hormones, or androgens, such as testosterone cause prostate cancer cells to grow. By lowering the levels of male hormones, this treatment may shrink tumors or slow their growth. Since hormone therapy can control but not cure prostate cancer, it often complements other therapies. It may involve surgical removal of the testicles, which produce testosterone, or more commonly the use of various drugs to lower hormone levels.

Most prostate cancer cells respond to androgen deprivation, but some continue to grow. Over time, hormone therapies become less effective. For this reason, drug therapies are often administered in on-again, off-again cycles. This approach may extend the treatment’s usefulness and offer patients respite from side effects. Medical studies are underway to determine the overall effectiveness of hormone therapies and the best ways to administer them.

Side effects of hormone therapy include reduced or eliminated sexual desire, impotence, weakened bones, anemia, hot flashes, breast growth and tenderness, fatigue, loss of muscle mass, reduced mental acuity, weight gain, lowered levels of “good” cholesterol, and depression. Some drugs may also cause diarrhea, nausea, and liver problems.

Chemotherapy

Chemotherapy employs oral or injected drugs to kill cancer cells. Historically, chemotherapy was not considered to be very effective against prostate cancer, but newer drugs show more promise. Still, like hormone therapy, chemotherapy may help control tumor growth and reduce symptoms but is not considered a cure.

Since chemotherapy kills some normal cells in addition to malignant ones, it can cause side effects that vary depending on the type of drug used. These side effects can include nausea, vomiting, hair loss, and mouth sores. These drugs can also cause anemia, which can increase the risk of infection, fatigue, and bleeding or bruising after minor injuries.

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Radiation Therapy

Radiation that kills cells or shrinks tumors may be used alone or in combination with other treatments for early stage, localized prostate cancer or for recurrent malignancy. Generally performed on an outpatient basis, radiation does not require urinary catheterization like surgical procedures, and it can be delivered in a variety of ways.

Brachytherapy

With this approach, radiation is delivered inside the body directly to the prostate. Low-dose methods involve permanently implanting radioactive seeds. The seeds give off small amounts of radiation for several weeks, so patients may be advised to stay away from children and pregnant women and to wear condoms during sex. Side effects such as impotence and problems with the bladder and bowels may occur less frequently with brachytherapy than with some other treatments. This radiation delivery method carries small risks associated with seed migration within the body.

Newer high-dose brachytherapy involves brief insertion of radioactive materials through needles placed in the prostate. Patients usually receive three treatments over a couple of days.

Both brachytherapy methods may cause pain and reddish-brown urine for a few days.

Traditional External-Beam Radiation

Radiation beams are focused on the affected area from outside the body. Men usually receive five outpatient treatments per week over a seven- to nine-week period. The treatment is quick and painless, but since nearby healthy tissue can be damaged, radiation can result in bowel and bladder problems as well as fatigue. While patients often don’t experience incontinence or impotence immediately after treatment, these conditions can develop over time.

Intensity-Modulated Radiation Therapy (IMRT)

Replacing traditional external-beam radiation therapy in a growing number of facilities is IMRT, which delivers higher radiation doses to cancerous tumors while avoiding healthy tissue. With IMRT, physicians can more effectively treat the disease while reducing the chance of side affects caused by damage to the bladder, bowels, and other organs. The precision of IMRT enables physicians to treat some cancers for which radiation therapy previously was not an option.

Click here for more detailed information about IMRT.

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