A cancer diagnosis is always scary, but luckily, most men with prostate cancer receive the diagnosis at an early stage. In fact, nine out of 10 men diagnosed with prostate cancer have tumors that are detected at the earliest stage.
For those who receive an early diagnosis, there are several treatment options to consider. Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors to consider such as your age and general health before you decide what to do. You should also think about the possible side-effects of treatment and how likely they are to bother you. Some men, for example, may want to avoid possible side-effects such as incontinence or erection problems for as long as possible. Other men are less concerned about side-effects and more concerned about removing or destroying the cancer.
If you’re older or have other serious health problems and your cancer is slow-growing (low-grade), you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death, but may cause symptoms you want to avoid. You may be more inclined to consider watchful waiting or active surveillance, and less inclined to consider treatments that are likely to cause side-effects, such as radiation and surgery.
If you’re younger and otherwise healthy, you might be more willing to accept possible side-effects of treatment if they offer you the best chance for cure. Most doctors believe that surgery, external radiation, and brachytherapy all have about the same cure rates for the earliest stage prostate cancers. However, there are pros and cons to each type of treatment that should be considered, and the benefits should be weighed against possible risks and side-effects.
Prostate Cancer Treatment Options
The goal of active surveillance (sometimes called watchful waiting) is to closely monitor your prostate cancer to determine when treatment should begin. No medical treatment is provided. Prostate cancer is often slow-growing and may not pose an immediate health risk for some men. This approach may be used for early stage cancer if the risks and possible side-effects outweigh the possible benefits of treatment. It may also be used for men with significant health problems such as other cancers, heart disease, or lung disease. Monitoring your prostate cancer will be done through regularly scheduled prostate-specific antigen (PSA) tests, digital rectal exams (DRE), and biopsies determined by you and your physician. If these tests show the prostate cancer has begun to grow at a faster pace or involve more of the prostate, you and your physician will decide if and when to initiate additional treatment.
Surgery: Radical Prostatectomy
The goal of surgery is to cure the cancer by removing the prostate and all the cancer cells. This approach is generally used for cancer that hasn’t spread outside of the prostate. Surgery lowers the long-term risk that the cancer will grow or spread, and the risk of death from cancer.
A radical prostatectomy removes the entire prostate, the seminal vesicles, part of the urethra that passes through the prostate, the end of the vas deferens and sometimes the surrounding lymph nodes. During this surgery the goal is to remove the cancer while maintaining your urinary control (continence) and your erectile function (potency). The nerves that control erections and help with continence are in very small bundles that run along the left and right sides of the prostate. When possible, the surgeon makes every effort to preserve these nerves. Your urologist will be able to tell you if these nerve bundles will be spared before surgery. Make sure to discuss this with your urologist.
The goal of radiation therapy is to kill or shrink cancer cells by using high-dose radioactive exposure. This treatment targets the cells of the prostate and the immediately surrounding tissues, while sparing other cells in the body. The exposure may come from outside the body (external beam) or within the body (internal beam/brachytherapy). External beam radiation is an advanced mode of high-precision radiotherapy that uses very small beams of radiation aimed at the tumor from many angles.
With internal beam radiation, or brachytherapy, the radiation comes from radioactive material contained in very small implants called seeds. During a surgical procedure, dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. Precise mapping is done prior to the surgery to ensure proper placement of the seeds. Over the course of several weeks to months, the seeds give off radiation to the immediately surrounding area, killing the cancer cells. Over time, the radioactive material degrades, and the seeds that remain are harmless.
Prostate cancer grows in the presence of male hormones called androgens or testosterone. Testosterone is produced in the testicles and the adrenal gland. The goal of hormone therapy is to decrease the size of the prostate and slow the growth of cancer by lowering the level of testosterone. This is accomplished through medications or surgical removal of the testicles called an orchiectomy. Medications can be taken orally or given by injection. Hormone therapy alone won’t cure the cancer. It’s typically used in more advanced cancers or can be used as a second form of treatment along with radiation.
This treatment may be provided by your urologist, radiation therapist, or medical oncologist. If you’re using multiple treatment approaches, all physicians involved in the treatment plan should communicate with one another.
The goal of cryosurgery is to kill the cancer cells by freezing them. It’s not a good option for men with large prostate glands or who have multiple disease sites. In this approach, several hollow probes (needles) are placed through the skin between the anus and scrotum. The doctor guides them into the prostate using transrectal ultrasound (TRUS). Very cold gases are passed through the needles, creating ice balls that destroy the cancer. Efforts are made to spare healthy tissue from freezing and warm saltwater is circulated through a catheter in the urethra to keep it from freezing. The catheter is kept in place for about three weeks while the patient recovers. Cryosurgery is less invasive than radical prostatectomy, so there’s usually less blood loss, a shorter hospital stay, a shorter recovery period, and less pain than with surgery.
Doctors know much less about the long-term effectiveness of cryosurgery because it’s a newer treatment for prostate cancer. Current techniques using ultrasound guidance and precise temperature monitoring have only been available for a few years. Outcomes of long-term follow-up care must still be collected and reviewed. For this reason, most doctors don’t often use cryotherapy as the first treatment option for prostate cancer. It’s sometimes recommended if the cancer has come back after other treatments or when patients are unable to undergo other treatment options.
Chemotherapy is the use of chemical agents to stop the growth of cancer cells. The goal of chemotherapy is to ease the symptoms of advanced prostate cancer by killing cancer cells that have spread to other parts of the body. It doesn’t cure prostate cancer, but can reduce the amount of disease, which can prolong survival and decrease cancer-related symptoms, especially pain. Chemotherapy is only used in advanced stage prostate cancer because it’s not curative and does have potential side-effects. It’s given intravenously, generally every three weeks.
Getting help with treatment decisions
Making complex decisions about how to treat prostate cancer is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues.
It’s important to know that every man’s experience with prostate cancer is different. Just because someone you know had a good (or bad) experience with a certain type of treatment doesn’t mean the same will be true for you.