Treatment for your prostate cancer is usually only chosen after a thorough evaluation. Your doctor will discuss the benefits and risks of each treatment choice.
Sometimes, your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Other times, your doctor will talk with you about two or more treatments that could be good for your cancer.
Factors you and your doctor must think about include:
Your age and other medical problems you may have
Side effects that occur with each type of treatment
How much the prostate cancer has spread
Your Gleason score, which tells your doctor how likely it is that cancer has already spread elsewhere
Ask your doctor to explain the following about your treatment choices:
Which choices offer the best chance of curing your cancer or controlling its spread for a long time
How likely it is that you will have different side effects and how they will affect your life.
Radical Prostatectomy (Prostate Removal)
Surgery to remove the prostate and some of the tissue around it is an option when the cancer has not spread beyond the prostate gland. This surgery is called radical prostatectomy.
Healthy men who will probably live 10 or more years often have this procedure.
Note: it is not always possible to know for certain before surgery is done whether the prostate cancer has already spread beyond the prostate gland.
Possible problems after surgery include difficulty controlling urine or bowel movements and erection problems.
Radiation therapy works best to treat prostate cancer that has not spread outside of the prostate. It may also be used after surgery, if there is a risk that prostate cancer cells may still be present. Radiation is sometimes used for pain relief when cancer has spread to the bone.
External beam radiation therapy uses high-powered x-rays pointed at the prostate gland.
It is done in a radiation oncology center usually connected to a hospital. You will come to the center from home 5 days a week for the treatments. The therapy lasts for 6 - 8 weeks.
Before treatment, a therapist will mark the part of the body that is to be treated with a special pen.
The radiation is delivered to the prostate gland using a device that looks like a normal x-ray machine. The treatment itself is generally painless.
Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions, rectal burning or injury, diarrhea, bladder urgency, and blood in urine. There are reports of secondary cancers arising from the radiation field as well.
Proton therapy is another kind of radiation used to treat prostate cancer. Doctors aim proton beams onto a tumor, so there is less damage to the surrounding tissue. This therapy is not widely accepted or used.
Brachytherapy is often used for men with smaller prostate cancer that is found early and is slow-growing. It also may be given with external beam radiation therapy for some patients with more advanced cancer.
Prostate brachytherapy involves placing radioactive seeds inside the prostate gland.
A surgeon inserts small needles through the skin beneath your scrotum to inject the seeds. The seeds are so small that you don't feel them.
They are permanent.
Side effects may include:
Pain, swelling, or bruising in your penis or scrotum, red-brown urine or semen
Impotence, incontinence, urinary retention, and diarrhea.
Testosterone is the body's main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is any treatment that decreases the effect of testosterone on prostate cancer.
Hormone therapy is mainly used in men whose cancer has spread to help relieve symptoms. These treatments can prevent further growth and spread of cancer but do not cure the cancer.
The primary type is called a luteinizing hormone-releasing hormones (LH-RH) agonist:
These medicines block the body from making testosterone. The drugs must be given by injection, usually every 3 - 6 months.
They include leuprolide, goserelin, nafarelin, triptorelin, histrelin, buserelin, and degarelix.
Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, decreased muscle mass, weight gain, and impotence.
The other medications used are called androgen-blocking drugs.
They are often given along with the above drugs. They include flutamide, bicalutamide, and nilutamide.
Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.
Much of the body's testosterone is made by the testes. As a result, removal of the testes (called orchiectomy) can also be used as a hormonal treatment.
Chemotherapy and immunotherapy are used to treat prostate cancers that no longer respond to hormone treatment. An oncology specialist will usually recommend a single drug or a combination of drugs
Antonarakis ES, Eisenberger MA. Expanding treatment options for metastatic prostate cancer. N Engl J Med. 2011 May 26;364(21):2055-8.
Wilt TJ, MacDonald R, et al. Systematic review: comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med. 2008;148(6):435-448.
Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.