Prostate Cancer Treatments

Watchful Waiting

There is no treatment with watchful waiting. Your doctor will do tests to see if the cancer is growing. Watchful waiting is for:

• Early stage prostate cancer that seems to be growing slowly
• Older prostate cancer patients or those with serious medical problems that may make the treatment risks outweigh the possible benefits

Surgery

Surgery involves removing the cancerous tumor and nearby tissues, and possibly nearby lymph nodes. Surgery is offered to patients who are in good health and are younger than 70 years old. Types of surgery:

• Pelvic lymphadenectomy—removal of lymph nodes in the pelvis to determine if they contain cancer
  • If they do, removal of the prostate and other treatment may be recommended.
• Radical retropubic prostatectomy —removal of the entire prostate and nearby lymph nodes through an incision in the abdomen
• Radical perineal prostatectomy —removal of the entire prostate through an incision between the scrotum and the anus
  • Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.
• Transurethral resection of the prostate (TURP) —removal of part of the prostate with an instrument inserted through the urethra
  • TURP is not a cancer surgery, but can be used to relieve the symptoms if you have either prostate cancer or an enlarged gland due to other reasons.

Prostate cancer surgery can cause impotence . It can also cause leakage of urine from the bladder or stool from the rectum. Nerve-sparing surgery may reduce these risks. But this kind of surgery may not effectively treat very large tumors or tumors that are very close to nerves.

Robotic surgery and laparoscopic surgery may be other options. These minimally invasive techniques can reduce side effects, blood loss, and recovery time.

Radiation Therapy

Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

• External radiation therapy—radiation is directed at the tumor from a source outside the body
• Internal radiation therapy—radioactive materials placed into the body near the cancer cells

Internal radiation therapy is often used for treating earlier stage cancers. Radiation therapy for prostate cancer may cause impotence and urinary problems. However, most studies show that impotence rates are less for radiation therapy than for standard prostatectomy and slightly less than that for nerve-sparing procedures. Rates of incontinence following radiation therapy are also less than following prostatectomy. But, there is an increased risk of cystitis due to radiation.

Hormone Therapy

Hormone therapy is used for patients whose prostate cancer has spread beyond the prostate or has recurred after treatment. The goal of hormone therapy is to lower levels of the male hormones, called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancers to shrink or grow more slowly, but does not cure cancer. Methods of hormone therapy include:

• Orchiectomy—a surgical procedure to remove one or both of the testicles, which are the main source of male hormones
  • Orchiectomy decreases hormone production. This can shrink or slow the growth of most prostate cancers.
• Luteinizing hormone-releasing hormone (LHRH) agonists—injections that can decrease the amount of testosterone made by the testicles
• Anti-androgens (eg, flutamide , bicalutamide )—medications that can block the action of androgens
  • These medications are used in combination with orchiectomy or LHRH agonists, a combination called total androgen blockade.
• Drugs that prevent adrenal glands from making androgens (eg, ketoconazole , aminoglutethimide )
• Estrogens—drugs that prevent the production of testosterone in the testicles
  • Estrogens are rarely used today because of the risk of serious side effects.

Hormone therapy for prostate cancer may cause:

• Hot flashes
• Impaired sexual function
• Loss of sexual desire
• Weakened bones

Other Treatment Options

Other treatments are being tested. Patients may want to consider taking part in a clinical trial when weighing treatment options. The treatments that are currently being tested include: