Treatment of Prostate Cancer

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Pacific Urology

Men with prostate cancer have many treatment options. The treatment that’s best for one man may not be best for another. The options include—

 

Active Surveillance/Watchful Waiting

ProstateActive surveillance may be chosen if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you’re diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.

Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.

If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months, at first). After about one year, your doctor may order another biopsy to check the Gleason score, the grading system of prostate cancer. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. You’ll receive surgery, radiation therapy, or another approach.

Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.

If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option for most men.

Surgery

Surgery is an option for men with stage I or stage II prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

Before removing the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Some of these are described here:

  • Open surgery: The surgeon makes a large incision into your body to remove the tumor. There are two approaches:
    • Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
    • Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
  • Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube, a laparoscope helps the surgeon remove the prostate.
  • Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
  • Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study.
  • TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

 

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy.

External radiation therapy uses a machine outside the body to send radiation toward the cancer. Among the external radiation technology options, the most advanced forms of radiation therapy include image-guided radiation therapy (IGRT), intensity modulated radiation therapy (IMRT), three-dimensional conformal radiation therapy, stereotactic radiosurgery, and Calypso GPS system.

 

The Calypso System

We are the first and only cancer treatment center in the East Bay offering cancer patients the breakthrough benefits of real-time tumor tracking during external beam radiation therapy with Calypso.

Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. There is an increased risk of bladder cancer and/or rectal cancer in men treated with radiation therapy. Impotence and urinary problems may occur in men treated with radiation therapy.

Hormone Therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the production of male hormones or block them from working.

Hormone therapy used in the treatment of prostate cancer may include the following:

  • Luteinizing hormone-releasing hormone agonists can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin.
  • Antiandrogens can block the action of androgens (hormones that promote male sex characteristics). Two examples are casodex and nilutamide.
  • Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide, or the brand new drug abiratarone.
  • Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, to decrease hormone production.
  • Estrogens (hormones that promote female sex characteristics) can prevent the testicles from producing testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects.

Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and pruritus (itching).

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Systemic chemotherapy– When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body.

Biologic Therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Treatment Options by Stage

Stage I Prostate Cancer

Treatment of stage I prostate cancer may include the following:

  • Watchful waiting.
  • Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery. It may be possible to remove the prostate without damaging nerves that are necessary for an erection.
  • External-beam radiation therapy.
  • Implant radiation therapy.

 

Stage II Prostate Cancer

Treatment of stage II prostate cancer may include the following:

  • Watchful waiting.
  • Radical prostatectomy, with or without pelvic lymphadenectomy. Radiation therapy may be given after surgery. It may be possible to remove the prostate without damaging nerves that are necessary for an erection.
  • External-beam radiation therapy with or without hormone therapy.
  • Implant radiation therapy.

 

Stage III Prostate Cancer

Treatment of stage III prostate cancer may include the following:

  • External-beam radiation therapy with or without hormone therapy.
  • Hormone therapy.
  • Radical prostatectomy, with or without pelvic lymphadenectomy. Radiation therapy may be given after surgery.
  • Watchful waiting.
  • Radiation therapy, hormone therapy, or transurethral resection of the prostate as palliative therapy to relieve symptoms caused by the cancer.

 

Stage IV Prostate Cancer

Treatment of stage IV prostate cancer may include the following:

  • Hormone therapy.
  • Chemotherapy
  • Biologic therapy
  • External-beam radiation therapy with or without hormone therapy.
  • Radiation therapy or transurethral resection of the prostate as palliative therapy to relieve symptoms caused by the cancer.
  • Watchful waiting.

 

Treatment Options for Recurrent Prostate Cancer

Treatment of recurrent prostate cancer may include the following:

  • Radiation therapy
  • Prostatectomy for patients initially treated with radiation therapy.
  • Hormone therapy
  • Chemotherapy
  • Biologic therapy
  • Pain medication, external radiation therapy, internal radiation therapy with radioisotopes such as strontium-89, or other treatments as palliative therapy to lessen bone pain.

 

Nutrition and Physical Activity

The right amount of calories is needed to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

Research shows that people with cancer feel better when they are active. Walking, yoga, swimming, and other activities can increase your energy. Exercise may reduce pain and make treatment easier to handle, may help relieve stress, and there is even evidence that you may live longer. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, tell your doctor.

Follow-up Care

You’ll need regular checkups after treatment for prostate cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor.

Your doctor will check for return of cancer. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment.

Checkups may include a physical exam with a digital rectal exam and a PSA test. A rise in PSA level can mean that cancer has returned after treatment. Your doctor may also order a biopsy, a bone scan, CT scans, an MRI, or other tests.

Sources
National Cancer Institute
Centers for Disease Control and Prevention