For some men, prostate cancer causes no symptoms or long-term issues, so treatment isn’t necessary. In these cases, doctors may recommend active surveillance. That is, they’ll keep an eye on the development of the tumor using various tools and tests:
Digital rectal examsProstate-specific antigen (PSA) blood testsTransrectal ultrasoundsProstate biopsies
Treatments — the most common of which are surgery, radiation therapy, and hormone therapy — may be started if symptoms develop or if the cancer appears to be growing and getting worse (or if treatment is specifically requested). (1)
Surgery for Cancer That Has Not Spread
Cancers isolated to the prostate are often treated with a type of surgery called a radical prostatectomy, in which the entire prostate gland, surrounding tissues, and seminal vesicles are removed. There are two main approaches to radical prostatectomy. During a retropubic prostatectomy, surgeons remove everything through an incision in the lower abdomen. The surgeon may also remove the nearby lymph nodes to see if the cancer has spread to other areas of the body through the lymphatic system. During the second type of surgery, a perineal prostatectomy, surgeons make the incision in the perineum, the area between the scrotum and anus. A second incision in the abdomen may be necessary to remove lymph nodes. This operation is shorter than a retropubic prostatectomy but has a higher risk of post-op erection problems, according to the American Cancer Society (ACS). Radical prostatectomies may also be performed laparoscopically, using thin fiber-optic instruments inserted into the body through multiple tiny incisions. Some laparoscopic prostatectomies are performed using a robotic system and are known as robotic prostatectomies. Laparoscopic procedures typically result in less post-op pain, shorter hospital stays, and quicker recovery, the ACS notes. Possible side effects of prostate cancer surgery include these complications:
Erectile dysfunction and changes in orgasmsUrinary incontinencePenile shorteningInguinal (groin) herniaLoss of fertility (2,3)
Radiation Therapy for a Variety of Cases
Radiation therapy, in which cancer cells are destroyed and prevented from growing using high-energy X-rays or other types of radiation, is typically used in these situations:
The cancer is isolated in the prostate gland.The cancer wasn’t removed completely or comes back after surgery.The cancer has spread to nearby tissues (in which case radiation is used in conjunction with hormone therapy).The cancer is advanced and needs to be reduced in size.
The therapy may be conducted with a machine outside of the body or with radioactive substances that are surgically placed into or near the cancer (brachytherapy). Radioactive substances, particularly radium-223, may also be injected in the veins to treat cancer that has spread to the bones, a treatment called alpha emitter radiation therapy. The side effects of radiation therapy include an increased risk for bladder and gastrointestinal cancer, erectile dysfunction, and urinary, bowel, and bladder problems. (4)
Hormone Therapy: A Mainstay for Many Patients
Hormone therapy is not a stand-alone therapy. It is usually used to shrink the cancer before treatment or to treat cancer that has spread beyond the prostate, come back after other treatments, or is high risk and may recur after treatment. It works by removing or blocking the action of hormones that can cause cancer cells to grow. Treatments include the following:
Drugs that stop the testicles from making testosteroneDrugs that block the action of testosterone and other androgens (male sex hormones)Drugs that prevent the adrenal glands from making androgensOrchiectomy, a surgical procedure to remove one or both testicles
Numerous side effects can result from hormone therapy:
Sexual dysfunctionWeakened bonesHot flashesGastrointestinal issuesItchingAnemia (low red blood cell counts)Breast tenderness and growth (5)
Other Prostate Cancer Treatments
Numerous other treatments may be used to treat prostate cancer, each of which has its own benefits, harms, and side effects. These include the following therapies:
Chemotherapy using a range of possible chemo agents, including docetaxel (Taxotere, Docefrez), cabazitaxel (Jevtana), or mitoxantroneBiologic therapy, or “vaccine” therapy, which uses the body’s immune system to fight the cancerCryosurgery, which aims to freeze (and kill) cancer cellsHigh-intensity focused ultrasound, which targets cancer cells with powerful sound wavesBisphosphonate therapy to treat cancer that has spread to the bones using bisphosphonate drugs, such as clodronate (Bonefos) or zoledronic acid (Reclast, Zometa) (2)
