Understanding Prostate Cancer treatment options

Prostate cancer treatment options such as surgery or radiation, depend on many factors. These factors include how fast your cancer is growing, how much the prostate cancer has spread, your overall health, as well as the benefits and the potential side effects of your treatment options.

For men diagnosed with a very early stage of prostate cancer, treatment may not be necessary right away. Some men may never need prostate cancer treatment. Instead, doctors sometimes recommend watchful waiting, which is sometimes called active surveillance. In watchful waiting, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer.

If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation. Watchful waiting may be an option for cancer that isn’t causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Watchful waiting may also be considered for a man who has another serious health condition or an advanced age that makes cancer treatment more difficult. Watchful waiting carries a risk that the cancer may grow and spread between checkups, making it less likely to be cured.

Radiation therapy

Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:

• Radiation that comes from outside of your body (external beam radiation). During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks. Most external beam radiation uses X-rays to deliver the radiation, but doctors are studying whether using protons may reduce the risk of side effects.
• Radiation placed inside your body (brachytherapy). Brachytherapy involves placing many rice-sized radioactive seeds in your prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. Your doctor implants the radioactive seeds in your prostate using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don’t need to be removed.

The side effects of radiation therapy can include painful urination, frequent urination and urgent urination, as well as rectal symptoms, such as loose stools or pain when passing stools. Erectile dysfunction can also occur. There is a small risk of radiation causing another form of cancer, such as bladder cancer or rectal cancer, in the future.

Hormone therapy

Hormone therapy is treatment to stop the body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:

• Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Eligard), goserelin (Zoladex), triptorelin (Trelstar) and histrelin (Vantas).
• Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells. Examples include bicalutamide (Casodex), flutamide and nilutamide (Nilandron). These drugs typically are given along with an LH-RH agonist or given before taking an LH-RH agonist.
• Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body. The effectiveness of orchiectomy in lowering testosterone levels is similar to that of hormone therapy medications, but orchiectomy may lower testosterone levels more quickly.

Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy. This can make it more likely that radiation therapy will be successful. Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind.

Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain. Hormone therapy also increases the risk of heart disease and heart attack.

Surgery to remove the prostate

Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Ways the radical prostatectomy procedure can be performed include:

• Making an incision in your abdomen. During retropubic surgery, the prostate gland is taken out through an incision in your lower abdomen. Compared with other types of prostate surgery, retropubic prostate surgery may carry a lower risk of nerve damage, which can lead to problems with bladder control and erections.
• Making an incision between your anus and scrotum. Perineal surgery involves making an incision between your anus and scrotum in order to access your prostate. The perineal approach to surgery may allow for quicker recovery times, but this technique makes removing the nearby lymph nodes and avoiding nerve damage more difficult.
• Laparoscopic prostatectomy. During a laparoscopic radical prostatectomy, several small incisions are made in the abdomen. The doctor inserts special surgical tools through the incisions, including a long, slender tube with a small camera on the end (laparoscope). The laparoscope sends images to a monitor in the operating room. The surgeon watches the monitor while guiding the instruments. Laparoscopic surgery may offer a shorter hospital stay and quicker recovery than traditional surgery.
• Using a robot to assist with surgery. During robotic laparoscopic surgery, the instruments are attached to a mechanical device (robot). The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Using a robot during laparoscopic surgery may allow the surgeon to make more precise movements with surgical tools than is possible with traditional laparoscopic surgery.

Discuss with your doctor which type of surgery is best for your specific situation.

Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction. Ask your doctor to explain the risks you may face based on your situation, the type of procedure you select, your age, your body type and your overall health.

Freezing prostate tissue

Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue. Initial attempts to use cryosurgery for prostate cancer resulted in high complication rates and unacceptable side effects. However, newer technologies have lowered complication rates, improved cancer control and made the procedure easier to tolerate. Cryosurgery may be an option for men who haven’t been helped by radiation therapy.

Heating prostate tissue using ultrasound

High-intensity focused ultrasound treatment uses powerful sound waves to heat prostate tissue, causing cancer cells to die. High-intensity focused ultrasound is done by inserting a small probe in your rectum. The probe focuses ultrasound energy at precise points in your prostate. High-intensity focused ultrasound treatments are being studied in clinical trials. More study is needed to understand the benefits and risks of this treatment.

Chemotherapy

Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both. Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don’t respond to hormone therapy.

From the National Cancer Institute, here is a list of treatment options by the stage. Make sure you ask the doctor what stage you are.

April 2015

Perhaps you will find this article about prostate cancer treatments in the UK of interest. We did. Here is the link.