What are the treatment options for prostate cancer?
Physicians design prostate cancer treatment plans to meet their patient's needs, based on the type of cancer, the age of the person, how far the cancer has spread, and the general health of the patient.
- Observation or surveillance. For men with low-risk cancer, observation (watching) may be the first strategy.
- Laparoscopic radical prostatectomy. A minimally invasive procedure, a laparoscopic radical prostatectomy removes the prostate gland. Unlike conventional surgery, a laparoscopic prostatectomy requires only five small (button-hole) incisions (cuts into the skin). Through these incisions, a surgeon uses a laparoscope—a tiny camera—and surgical instruments to perform the operation and remove the prostate.
- Robotic radical prostatectomy. During this procedure, surgeons use a robot to guide the laparoscope through small incisions to remove the cancerous prostate and any other tissue that might be affected. Various robotic systems are available, which may consist of a 3-armed robot connected to a remote console. The surgeon operates the system while seated at the console. Foot pedals are used for control, and three-dimensional displays give the surgeon sharp, detailed views of the surgical field.
- Open radical prostatectomy. Open radical prostatectomy removes the entire prostate with an incision in the lower abdomen. Because the prostate wraps around the urethra, the surgeon must reconnect the bladder with the urethra after removing the prostate.
- Radiation therapy. Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation can be produced in two ways: external radiation, which comes from a machine outside the body; or internal radiation, in which materials that produce radiation (radioisotopes) are placed through thin plastic tubes into the area in which the cancer cells are found.
- Interstitial brachytherapy (seed implantation). Interstitial brachytherapy is a form of radiation therapy. A radiation oncologist and urologist place radioactive pellets or "seeds" into the prostate, and the pellets release radiation into the prostate and nearby tissue over time.
- Intensity-modulated radiotherapy. This is an advanced form of radiation therapy that can shorten the length of prostate cancer treatment by several weeks. High doses of radiation (guided by a computer) are delivered directly to the tumor, which reduces the risk to normal tissue.
- Cryotherapy. Small needle-shaped probes are inserted into the prostate to freeze it and kill the prostate cancer. This procedure, which is minimally invasive and does not require an incision, is performed either on an outpatient basis (the patient goes home the day of surgery) or with a one-night hospital admission. Patients recover in a matter of days and usually have very few after effects.
- Hormone therapy. Hormone therapy changes the body's hormone balance to prevent certain cancers from growing. Hormone therapy may be done using drugs that change the way hormones work, or with surgery that removes hormone-producing organs such as the testes.
- Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken orally (by mouth) or injected into a vein. Chemotherapy is usually a systemic treatment, which means that the drugs enter the bloodstream, travel through the body, and can kill cancer cells anywhere in the body, including the prostate.
It’s important to note that PSA levels decrease after the prostate has been removed. If the prostate gland was totally removed to treat prostate cancer, a new rise in the PSA level may mean that the tumor has come back. Additional tests would then be needed to learn why the PSA level has increased.
Which prostate cancer treatment should I choose?
The type of treatment is mostly a matter of patient choice. You'll want to consider the pros and cons of each option for your own situation, and how aggressive and advanced your cancer is. As you begin your decision-making process, here are some issues to think about.
- Ask your doctor about the stage and grade of your cancer. This will give you information on how aggressive your cancer is. With this information, you and your doctor can discuss the risk that your cancer poses to your well-being and longevity, how well each treatment option might work in your situation, and what the treatment side effects might be.
- Consider your age and health. Younger patients in their 40s and 50s with decades of life ahead may choose to treat the cancer aggressively. Cancer discovered in men in their 70s is likely to be slow-growing and may not have time to affect their life before they would die of other causes. Poor health adds to the complexity and makes treatment more risky.
- Think about your quality of life after treatment. Radiation can cause impotence and other urinary and rectal symptoms. Surgery can cause impotence and incontinence. So there are some difficult trade-offs to make in the face of uncertainty. Some men fear their sex lives may change, others are more fearful of dying or the anxiety of untreated cancer and prefer treatment despite the potential side effects.
- Make sure you are getting balanced and impartial information. If your doctor is a surgeon, you may want to talk with a radiation therapist, and vice versa. Make sure you feel comfortable discussing all of your options with all of your doctors and that they have taken the time to answer all of your questions. You should also do your own research and not just rely on your doctor's opinion. Consult with your doctors armed with your questions. It is important to ask about your doctor's personal expertise and experience in treating cancers like yours, as this can help determine a successful outcome.
- Ask yourself how well you tolerate uncertainty and repeated doctor's visits to deal with your cancer. If you are considering "active surveillance," can you deal with knowing that you have an untreated cancer inside your body? Will you follow through with office visits to your doctor for repeat testing? Would more aggressive treatment fit your personality and anxiety level?