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Prostate Cancer: Understanding Your Treatment Options

 

Different types of treatment are available for men with prostate cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for people with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Four types of standard treatment are used: watchful waiting, surgery, radiation therapy, and hormone therapy.

Watchful Waiting
This involves closely monitoring a person’s condition without giving any treatment until symptoms appear or change. This is usually used in older men with other medical problems and in early-stage disease.

Surgery
Men in good health are usually offered surgery as treatment for prostate cancer. The following types of surgery are used:

• Pelvic lymphadenectomy is a surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.
• Radical prostatectomy is a surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are two types of radical prostatectomy. Retropubic prostatectomy is a surgical procedure to remove the prostate through an incision in the abdominal wall. Removal of nearby lymph nodes may be done at the same time. Perineal prostatectomy is a surgical procedure to remove the prostate through an incision made in the perineum (area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen.
• Transurethral resection of the prostate (TURP) is a surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.

Men in good health are usually offered surgery as treatment for prostate cancer.

Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

Radiation Therapy
This 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. 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 also may occur in men treated with radiation therapy.

Hormone Therapy
This is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. 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 flutamide and nilutamide.
• Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.
• 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).

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing.

Clinical Trials
New types of treatment are being tested in clinical trials. The following describes treatments that are being studied in clinical trials; however, it may not mention every new treatment being studied.

• Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. This type of treatment is also called cryotherapy. Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with cryosurgery.
• 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. 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. When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
• Biologic therapy is a treatment that uses the person’s own 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.
• High-intensity focused ultrasound is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves.
• Proton beam radiation therapy is a type of high-energy, external radiation therapy that targets tumors with streams of protons (small, positively charged particles). This type of radiation therapy is being studied in the treatment of prostate cancer.

For some people, taking part in a clinical trial may be the best treatment choice. Many of today’s standard treatments for cancer are based on earlier clinical trials. People who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Clinical-trial participants help improve the way cancer will be treated in the future.

Follow-Up Tests
After treatment for prostate cancer, follow-up tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred.

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