Prostate Cancer

Management and Treatment

How is prostate cancer managed or treated?

Your treatment depends on multiple factors, including your overall condition, if the cancer’s spread and how fast it’s spreading. Depending on your treatments, you may work with various healthcare providers, including urologists, radiation oncologists and medical oncologists. Most prostate cancer diagnosed in the early stages can be cured with treatment.

Specific procedures used

Surveillance

Your healthcare provider may monitor your condition instead of providing treatment if your cancer grows slowly and doesn’t spread.

• Active surveillance: You get screenings, scans and biopsies every one to three years to monitor cancer growth. Active surveillance works best if the cancer grows slowly, is only in your prostate and isn’t causing symptoms. If your condition worsens, your provider can start treatments.
• Watchful waiting: Watchful waiting is similar to active surveillance, but it’s more commonly used for people who are frailer with cancer that likely won’t go away with treatment. Also, testing is much less frequent. Instead of eliminating the tumor, treatments usually focus on managing symptoms.

Surgery

A radical prostatectomy removes a diseased prostate gland. It can often successfully eliminate prostate cancers that haven’t spread. Your provider can recommend the best removal method if they believe you’d benefit from this surgery.

• Open radical prostatectomy: Your provider makes a single cut (incision) into your abdomen — from your belly button to your pubic bone — and removes your prostate gland. This technique isn’t as common as less-invasive methods like robotic prostatectomy.
• Robotic radical prostatectomy: Robotic radical prostatectomy allows your provider to perform surgery through several tiny incisions. Instead of operating directly, they operate a robot system via a console.

Radiation therapy

You may receive radiation therapy as a standalone treatment for prostate cancer or in combination with other treatments. Radiation can also provide symptom relief.

• Brachytherapy: A form of internal radiation therapy, brachytherapy involves placing radioactive seeds inside your prostate. This approach kills cancer cells while preserving surrounding healthy tissue.
• External beam radiation therapy: With external beam radiation therapy (EBRT), a machine delivers strong X-ray beams directly to the tumor. Specialized forms of EBRT, like IMRT, can direct high doses of radiation toward the tumor while sparing healthy tissue.

Systemic therapies

Your provider may recommend systemic therapies if cancer has spread outside your prostate gland. Systemic therapies send substances throughout your body to destroy cancer cells or prevent their growth.

• Hormone therapy: The hormone testosterone boosts cancer cell growth. Hormone therapy uses medications to combat testosterone’s role in fueling cancer cell growth. The medicines work by preventing testosterone from reaching cancer cells or by reducing your testosterone levels. Alternatively, your provider may recommend surgery to remove your testicles (orchiectomy) so they can no longer make testosterone. This surgery is an option for people who don’t want to take medications.
• Chemotherapy: Chemotherapy uses medicines to destroy cancer cells. You may receive chemotherapy alone or with hormone therapy if your cancer has spread beyond your prostate.
• Immunotherapy: Immunotherapy strengthens your immune system so it’s better able to identify and fight cancer cells. Your healthcare provider may recommend immunotherapy to treat advanced cancer or recurrent cancer (cancer that goes away but then returns).
• Targeted therapy: Targeted therapy zeroes in on the genetic changes (mutations) that turn healthy cells into cancer cells to prevent them from growing and multiplying. Targeted therapies that treat prostate cancer destroy cancer cells with BRCA gene mutations.

Focal therapy

Focal therapy is a newer form of treatment that destroys tumors inside your prostate. Your healthcare provider may recommend this treatment if the cancer is low-risk and hasn’t spread. Many of these treatments are still considered experimental.

• High-intensity focused ultrasound (HIFU): High-intensity sound waves generate powerful heat to kill cancer cells within your prostate.
• Cryotherapy: Cold gases freeze cancer cells in your prostate, eliminating the tumor.
• Laser ablation: Intense heat directed at the tumor kills cancer cells within your prostate, destroying the tumor.
• Photodynamic therapy: Medications make cancer cells more sensitive to certain wavelengths of light. A healthcare provider exposes cancer cells to these light wavelengths, killing the cancer cells.

What are the side effects of prostate cancer treatment?

Potential side effects include:

• Incontinence: You may leak urine when you cough or laugh or feel an urgent need to pee even when your bladder isn’t full. This problem usually improves over the first six to 12 months without treatment.
• Erectile dysfunction (ED): Surgery, radiation and other treatments can damage the erectile nerves in your penis and affect your ability to get or maintain an erection. It’s common to regain erectile function within a year or two (sometimes sooner). In the meantime, medications like sildenafil (Viagra®) or tadalafil (Cialis®) can help by increasing blood flow to your penis.
• Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in infertility. If you want children in the future, you can preserve sperm in a sperm bank before starting treatment. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into your partner’s uterus.

Talk to your healthcare provider if you’re experiencing treatment side effects. Often, they can recommend medicines and procedures that can help.