Prostate cancer treatment options

There are many treatment options for prostate cancer, and they vary given the patient’s stage of cancer, age, health status and lifestyle preferences. Sorting through it all can become confusing, so it’s smart to take the time to learn about prostate cancer. It’s also helpful to talk with friends who’ve been diagnosed with prostate cancer and ask them about their experiences with various treatments. This guide will help you better understand the available treatment options.

To treat or not to treat

The first decision you need to make is whether or not to treat the cancer. If you have a small, slow-growing, localized tumor and you’re in his seventies, it may not become a life-ending cancer. So, you might be advised to carefully watch the cancer’s development – known  “active surveillance” – which involves blood work and exams performed every six months as well as an annual biopsy of the prostate. 

Common treatments

If treatment is recommended over “active surveillance,” you will need to consider the following options:

• Surgery: A radical prostatectomy removes the entire prostate gland, including some surrounding tissue. It’s a serious operation involving a hospital stay of two to three days. The most common complications are incontinence and erectile dysfunction. To deal with potential impotence, surgeons have been testing a new technique known as a “sural nerve graft.” You should ask your surgeon about this option, and make sure that your insurance will cover the procedure as some insurance companies still see this as experimental and will not cover it. Surgeons can also remove the prostate through a laparoscope, which means they don’t have to make a long incision in the lower abdomen, resulting in a shorter recovery.

• Radiation: This is done on an outpatient basis, usually five days a week for up to about nine weeks. Radiation can be directed at the cancer externally or internally. External radiation uses computers to map out the cancer in three dimensions, known as 3D-CRT, sending very precise beams at the tumor. Intensity modulated radiation therapy (IMRT) goes a step further by delivering specific doses of radiation to different regions within the tumor itself. Side-effects from radiation may include bowel problems such as rectal bleeding, bladder complications such as an urgency to urinate, and fatigue. Subsequent damage to nerves and blood vessels can also cause impotence – and for some men – it will be permanent. Internal radiation is known as brachytherapy or “seed therapy.” In this instance, radioactive pellets are injected permanently into the prostate attacking cancer cells for several weeks. Another procedure, known as “high-dose brachytherapy,” places small catheters filled with radiation into the prostate. It’s a very short procedure, lasting anywhere between 5-15 minutes. Side-effects are similar to radiation therapy.

• Hormone therapy: Hormone therapy is sometimes offered to supplement either radiation therapy or surgery. “Androgen Deprivation Therapy” blocks male hormones from fostering the growth of prostate cancer cells.

What to ask

The Prostate Cancer Foundation suggests that you ask the following questions for any option your doctor recommends:

• Given the staging of the cancer, my health and age, why is this treatment the right approach for me?

• If surgery is being recommended, ask:

• Which surgical technique will be used and how often do you do it?
• Can you use a nerve-sparing technique so I won’t have erectile dysfunction following surgery?
• What’s your success rate in preserving potency and bladder control?
• What will you do if you find cancer outside of my prostate during the surgery?
• What can I expect following the surgery in terms of recovery time?
• How long will it be before I can return to my normal activities?
• What are the side effects of the surgery, both short- and long term?
• What will we do to monitor my prostate cancer following the surgery?

• If radiation therapy is being recommended, ask what type and what are the possible side effects.

For a free copy of Report to the Nation on Prostate Cancer: A Guide for Men and Their Families, call 1.800.757.CURE or go to pcf.org/guide.

The bottom line

• There are many treatment options for prostate cancer, and they vary given the patient’s stage of cancer, age, health status and lifestyle preferences.
• In some cases, the recommended treatment is “active surveillance” where the tumor is monitored but not treated because it likely isn’t “life ending.”
• Common treatments for prostate cancer include surgery, radiation and hormone treatment, each with it’s own risks and side effects. It’s important to ask your doctor questions about the recommended treatment so that you can make informed decisions about your options.
• For a free copy of Report to the Nation on Prostate Cancer: A Guide for Men and Their Families, call 1.800.757.CURE or go to pcf.org/guide.