Prostate Cancer Treatment

Many options may be considered

Treatment varies from person to person.
Age, overall health, stage and grade of tumor, and PSA levels all factor into a prostate cancer treatment plan.
For a man with advanced prostate cancer, many strategies may be used to treat the cancer.All treatment options can cause side effects, some life-threatening. All treatment options and risks should be discussed with your healthcare team.

This Web page provides information on the most common ways of treating prostate cancer. Work with your doctor and the other members of your healthcare team to create the treatment plan that's right for you.

Learn more about a specific treatment:

• Surgery
• Radiation
• Cellular immunotherapy
• Hormone therapy
• Chemotherapy

Surgery

Surgery is a common treatment for early-stage cancer.
When a cancer is confined to the actual prostate gland, or localized (it is stage I or II and has a low Gleason score), surgery is often recommended. It may also be recommended for younger men who are in good health.

One common type of prostate cancer surgery is called a radical prostatectomy. During a radical prostatectomy, a surgeon removes the entire prostate gland and sometimes the nearby lymph nodes, along with the seminal vesicles and other surrounding tissues. “Nerve-sparing” radical prostatectomies leave intact the nerves to the penis that control erections.

Another type of prostate cancer surgery is cryosurgery.
Cryosurgery, also called cryotherapy, is a relatively new technique which uses very cold gasses to freeze and destroy the prostate. Cryosurgery also often comes with side effects, such as incontinence and impotence.

Radiation

Radiation therapy uses X-rays to kill cancer cells.
Using high-energy X-rays, emitted either by a machine or by implanted radioactive “seeds,” radiation therapy kills cancer cells in the prostate. Radiation therapy sometimes serves as an alternative to surgery, or it may be used after surgery to kill any remaining cancer cells.

The types of radiation therapy are external beam radiation and brachytherapy (“seed” implantation).

Cellular immunotherapy

Cellular immunotherapy is used to treat advanced prostate cancer that is no longer responding to hormone therapy. It is thought to work by helping the body’s own immune system identify and attack prostate cancer cells.

One example of cellular immunotherapy is obtained by a patient’s immune cells from the blood, and then using a machine in a process known as leukapheresis.

To enhance their response against the cancer, the immune cells are then exposed to a protein that is found in most prostate cancers, linked to an immune-stimulating substance. After this process, the patient’s own cells are returned to the patient to treat the prostate cancer.

This treatment is given as a series of 3 infusions into a vein, with about 2 weeks between each infusion.

Hormone therapy

For advanced prostate cancers, treatments that target the whole body are used.
Hormone therapy may slow the advance of a tumor by shrinking it. Hormone therapy may be given before surgery or radiation therapy. And sometimes hormone therapy is used after surgery or radiation therapy to prevent prostate cancer from coming back.

Because hormones are found throughout the body, hormone therapy can fight cancers that have spread beyond the prostate gland. Hormone therapy cannot cure prostate cancer, but, for some men, it can stop the disease from getting worse.

Hormone therapy targets testosterone.
Hormone therapy targets prostate cancer by cutting off the male hormones (called androgens), which make prostate cancer grow. The main androgen is testosterone, produced in the testes. Testosterone is usually the target of hormone therapy.

To reduce the amount of testosterone in the body, the testicles can be removed surgically (this is called orchiectomy or castration), or medications can be used.

Hormone drugs can cut off the supply of testosterone.
Here are some of the types of hormone drugs used to treat prostate cancer:

• Luteinizing hormone-releasing hormone (LHRH) analogs. These medicines lower the amount of androgens that the testicles produce. LHRH analogs are the most common drugs used for lowering the levels of testosterone in the body
• Female hormones (estrogens). These block the release of testosterone.
• Antiandrogens. These block the activity of androgens

When hormones fail to stop the spread of prostate cancer, it is classified as hormone refractory. The next step is usually treatment with chemotherapy.

Chemotherapy

As a cancer spreads, chemotherapy is another treatment option.
Chemotherapy, or “chemo,” is a systemic treatment, meaning it can fight cancer throughout the body. Chemotherapy may be given orally (through the mouth) or by infusion (using an IV).

Chemotherapy is often used to treat advanced prostate cancer if hormone therapy is no longer working. Chemo may shrink a tumor or stop it from spreading, and can affect cancer at different sites in the body.

Chemotherapy may be used as a form of palliative therapy to try to relieve symptoms caused by the cancer, such as pain, or problems with breathing and swallowing.

The multidisciplinary team

Each man fighting prostate cancer is going to have a different experience.
So it's important that you talk to your whole healthcare team, or multidisciplinary team—meaning a group of doctors with different specialties. This team can include:

• Your primary physician
• A urologist, or doctor who specializes in diseases of the urinary system and male reproductive system