Prostate cancer is most treatable and curable if caught in the earliest stage of the disease. Some types of prostate cancer grow very slowly. However, prostate cancer can often be an aggressive, rapidly growing type of cancer.
Treatment is individualized to the type and stage of advancement of prostate cancer, a person's age, medical history, coexisting diseases, and other factors. Treatment for prostate cancer is delivered by a team of specialists in prostate cancer care. These specialists can include medical oncologists, urologists, surgeons, oncology nurses, registered dietician, and radiation oncologists.
Treatment of prostate cancer may include a combination of monitoring or surveillance (watchful waiting), surgery, hormone therapy, chemotherapy, and radiation therapy. Watchful waiting may be recommended if the type of prostate cancer is at an early stage, is growing slowly, and the man is in his older years.
Surgery for early stage prostate cancer may include a radical prostectomy (removal of the prostate gland). Hormone therapy may be used to suppress the growth of cancer cells. Radiation therapy, delivered internally or externally, may be prescribed to kill cancer cells. Chemotherapy may be prescribed for advanced prostate cancer that has spread to other areas of the body.
It may also be recommended that a person with prostate cancer enroll in a clinical trial of new therapies and treatments for prostate cancer.
For people whose prostate cancer has metastasized and has become terminal, the goals of treatment generally may change. Treatment then shifts away from curing the disease and focuses on measures to keep a person comfortable and maximize the quality of life. This treatment may be administered through a hospice program.
The list of treatments mentioned in various sources for Prostate Cancer includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
Alternative treatments or home remedies that have been listed as possibly helpful for Prostate Cancer may include:
The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Prostate Cancer may include:
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Possibly curable types of Prostate Cancer may include:
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Some of the different medications used in the treatment of Prostate Cancer include:
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Doctors have
several ways to treat prostate cancer. The choice depends on many
factors, such as whether or not the cancer has spread beyond the
prostate, the patient’s age and general health, and how the patient
feels about the treatment options and their side effects. Approaches
to treatment include:
Watchful waiting. Some men
decide not to have treatment immediately if the cancer is growing
slowly and not causing symptoms. Instead, they have regular checkups
so they can be closely monitored by their doctor. Men who are older
or have another serious illness may choose this option.
Surgery usually removes the entire prostate and
surrounding tissues. This operation is called a radical
prostatectomy. In the past, impotence was a side effect for nearly
all men undergoing radical prostatectomy. But now, doctors can
preserve the nerves going to the penis so that men can have
erections after prostate removal.
Incontinence, the
inability to hold urine, is common for a time after radical surgery
for cancer. Most men regain urinary control within several weeks. A
few continue to have problems that require them to wear a device to
collect urine.
Another kind of surgery is a
transurethral resection, which cuts cancer from the
prostate but does not take out the entire prostate. This operation
is sometimes done to relieve symptoms caused by the tumor before
other treatment or in men who cannot have a radical prostatectomy.
Radiation therapy uses high energy rays to kill
cancer cells and shrink tumors. It is often used when cancer cells
are found in more than one area. Impotence may occur in men treated
with radiation therapy.
Hormone therapy uses
various hormones to stop cancer cells from growing. It is used for
prostate cancer that has spread to distant parts of the body. Growth
of breast tissue is a common side effect of hormone therapy. (Source: excerpt from Prostate Problems -- Age Page -- Health Information: NIA)
If the physical exam and test results do not suggest cancer, the doctor may recommend medicineto reduce the symptoms caused by an enlarged prostate. Surgery is another way to relieve these symptoms. The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. (Patients may want to ask whether other procedures might be appropriate.) (Source: excerpt from What You Need To Know About Prostate Cancer: NCI)
Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy, or hormonal therapy. Some patients receive a combination of therapies. In addition, doctors are studying other methods of treatment to find out whether they are effective against this disease. (The "Promise of Cancer Research " section has information about research studies.)
Watchful waiting may be suggested for some men who have prostate cancer that is found at an early stage and appears to be slow growing. Also, watchful waiting may be advised for older men or men with other serious medical problems. For these men, the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits. Men with early stage prostate cancer are taking part in a study to determine when or whether treatment may be necessary and effective. (Source: excerpt from What You Need To Know About Prostate Cancer: NCI)
Surgery is a common treatment for early stage prostate cancer. The doctor may remove all of the prostate (a type of surgery called radical prostatectomy ) or only part of it. In some cases, the doctor can use a new technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.
The doctor can describe the types of surgery and can discuss and compare their benefits and risks.
In radical retropubic prostatectomy, the doctor removes the entire prostate and nearby lymph nodes through an incision in the abdomen .
In radical perineal prostatectomy, the doctor removes the entire prostate through an incision between the scrotum and the anus . Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.
In transurethral resection of the prostate (TURP), the doctor removes part of the prostate with an instrument that is inserted through the urethra. The cancer is cut from the prostate by electricity passing through a small wire loop on the end of the instrument. This method is used mainly to remove tissue that blocks urine flow.
If the pathologist finds cancer cells in the lymph nodes, it is likely that the disease has spread to other parts of the body. Sometimes, the doctor removes the lymph nodes before doing a prostatectomy. If the prostate cancer has not spread to the lymph nodes, the doctor then removes the prostate. But if cancer has spread to the nodes, the doctor usually does not remove the prostate, but may suggest other treatment.
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These are some questions a patient may want to ask the doctor before having surgery:
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Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill cancer cells. Like surgery, radiation therapy is local therapy ; it can affect cancer cells only in the treated area. In early stage prostate cancer, radiation can be used instead of surgery, or it may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages, it may be given to relieve pain or other problems.
Radiation may be directed at the body by a machine (external radiation ), or it may come from tiny radioactive seeds placed inside or near the tumor (internal or implant radiation , or brachytherapy ). Men who receive radioactive seeds alone usually have small tumors. Some men with prostate cancer receive both kinds of radiation therapy.
For external radiation therapy, patients go to the hospital or clinic, usually 5 days a week for several weeks. Patients may stay in the hospital for a short time for implant radiation.
Hormonal therapy keeps cancer cells from getting the male hormones they need to grow. It is called systemic therapy because it can affect cancer cells throughout the body. Systemic therapy is used to treat cancer that has spread. Sometimes this type of therapy is used to try to prevent the cancer from coming back after surgery or radiation treatment.
There are several forms of hormonal therapy:
Orchiectomy is surgery to remove the testicles, which are the main source of male hormones.
Drugs known as luteinizing hormone-releasing hormone (LH-RH) agonists can prevent the testicles from producing testosterone. Examples are leuprolide , goserelin , and buserelin .
Drugs known as antiandrogens can block the action of androgens. Two examples are flutamide and bicalutamide .
Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide .
After orchiectomy or treatment with an LH-RH agonist, the body no longer gets testosterone from the testicles. However, the adrenal glands still produce small amounts of male hormones. Sometimes, the patient is also given an antiandrogen, which blocks the effect of any remaining male hormones. This combination of treatments is known as total androgen blockade . Doctors do not know for sure whether total androgen blockade is more effective than orchiectomy or LH-RH agonist alone.
Prostate cancer that has spread to other parts of the body usually can be controlled with hormonal therapy for a period of time, often several years. Eventually, however, most prostate cancers are able to grow with very little or no male hormones. When this happens, hormonal therapy is no longer effective, and the doctor may suggest other forms of treatment that are under study. (Source: excerpt from What You Need To Know About Prostate Cancer: NCI)
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