Prostate Cancer Treatment Options

There's no single option that’s right for every man with prostate cancer. Some tumors grow very slowly or not at all, so you may never need treatment. Others grow faster and spread to different places in your body. In either case, you and your doctor will work together to decide what's best for you.

The treatment you need will depend on a few things:

• Your age, health, and lifestyle
• How serious your prostate cancer is (how large the tumor is and if it has spread in your body)
• Your thoughts (and your doctor’s opinion) about if you need to treat the cancer right away
• Possible side effects
• The chance that a treatment will help or cure your cancer

The most common prostate cancer treatments are:

Watchful waiting. If you have a small, slow-growing tumor, you and your doctor may decide to wait until you have symptoms to initiate treatment.

Active surveillance. You may have regular PSA (prostate-specific antigen) blood tests, rectal exams, ultrasounds, and biopsies to see if the cancer is getting worse. If it starts to grow or spread, you can explore other treatments.

Surgery. It’s an option if you're healthy and your cancer hasn't spread. There are several types. Your doctor may remove only your prostate gland. Or they might take it and the tissue around it. The most common side effects from an operation are problems controlling your urine and trouble getting and keeping an erection. Sometimes, they go away on their own after surgery, especially bladder control issues. Talk to your surgeon beforehand to see if they think they'll be able to protect the nerves around your prostate to prevent these side effects.

Radiation therapy. This treatment uses high-energy beams (similar to X-rays) to kill the cancer. It's often a choice for older men and for those with other health problems. You also might have it after surgery to get rid of any cancer cells left behind. It also helps for cancer that has spread to the bone. There are two types of radiation:

• External. A machine outside your body directs rays at the cancer.
• Internal (brachytherapy). A doctor does surgery to place small radioactive "seeds" into or near the cancer.

Sometimes, a mix of both treatments works best.

Hormone therapy. Prostate cancer cells need male sex hormones, like testosterone, to keep growing. This treatment keeps the cancer cells from getting them. Hormone treatment (also called androgen deprivation therapy or androgen suppression therapy) removes, blocks, or adds hormones.

It may include:

• Drugs such as anti-androgens that block male hormones in the body
• Drugs that lower testosterone levels, including luteinizing hormone-releasing hormone (LHRH) analogs or agonists; newer agents may also block the production of androgens by the adrenal glands
• Combined hormone therapy that decreases testosterone production from the testicles, as well as from the adrenal glands
• Surgical removal of the testicles (called orchiectomy)

Hormone treatment is often used if cancer has spread outside the prostate. It is also used if cancer remains or comes back after treatment with surgery or radiation. It does not cure cancer. The purpose of hormone therapy is to slow the cancer’s growth and increase survival while maximizing quality of life.

Hormone treatment is often used after surgery for better results, as well as in men who don't want to have any other type of treatment or who have advanced prostate cancer.

Cryotherapy. If you have early prostate cancer, your doctor might choose to kill cancer cells by freezing them. They’ll put small needles or probes into your prostate to deliver very cold gasses that destroy the cells. Your doctor may suggest whole gland cryosurgery for low- and intermediate-risk localized prostate cancer patients who are not suitable for either radical prostatectomy or radiotherapy.

It’s hard to say for sure how well it works. Scientists haven’t done much long- term research that focuses on using it to treat prostate cancer. It's usually not the first treatment option a doctor recommends.

Chemotherapy. This treatment uses drugs to shrink or kill prostate cancer cells. You can take the drugs by mouth or have them injected into your bloodstream. Most men with early prostate cancer don’t get chemo. It’s usually only for advanced cases or when the cancer has spread to other parts of the body.

Cancer vaccine. Most work by boosting your body's defenses so it can fight an infection. The prostate cancer vaccine gets your immune system to attack cancer cells. This treatment works best if you’ve tried hormone therapy and it isn't working anymore. The vaccine is custom-made for you. Scientists don’t know if it stops or slows down the cancer’s growth, but it does seem to help men live longer with prostate cancer.

Bone-directed treatment. If the cancer reaches your bones, drugs called bisphosphonates can help ease pain and prevent breaks. Your doctor may also suggest a medication given in your veins that sends radiation directly to bones.

High-intensity focused ultrasound. This device produces sound waves that deliver heat energy to kill cancer cells. It’s unclear how well it works as it hasn’t yet been compared with other standard prostate cancer treatments.

Proton beam therapy. This uses a beam of protons to irradiate diseased tissue. It is another option for treatment of localized prostate cancer, but it offers no real advantage over other forms of definitive treatment.

Putting it all together. You may start with one of these treatments and change it, or your doctor might mix different treatments. You’ll work together to find the best plan.

Mental Health Support

A prostate cancer diagnosis can change the way you look at yourself, your body, and your life. This is not unusual. Support from family, friends, and loved ones can help you regain your mental balance, but some people can benefit from mental health support.

For example, if you have new depression or anxiety that goes on for many weeks or starts to interfere with your work and family relationships, you may want to consider professional help.

Your health care team can help you integrate this into your total treatment plan. They can also connect you with the right support groups and mental health counseling services, often for free.

Clinical Trials for Prostate Cancer

Major pharmaceutical companies continually research and develop medications and treatments, which must be shown to be safe and effective before the FDA approves them and doctors can prescribe them to patients. Through prostate cancer clinical trials, researchers test the effects of new medications on a group of volunteers with prostate cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the drugs under development and measure how well they treat prostate cancer, their safety, and any possible side effects.

Some people with prostate cancer are reluctant to join clinical trials for fear of getting no treatment at all. This is not true. You’ll get the most effective therapy available for your condition, or you might receive prostate cancer treatments that are being evaluated for future use. These drugs may be even more effective than the current treatment.

These websites offer information and services to help you find a prostate cancer clinical trial that is right for you:

TrialCheck. This website, developed by the nonprofit Coalition of Cancer Cooperative Groups, is an unbiased cancer clinical trial matching and navigation service that lets you search for cancer trials based on disease and location.

National Cancer Institute. This website lists more than 6,000 cancer clinical trials and explains what to do when you find one that you think is right for you.

ClinicalTrials.gov. This website offers up-to-date information for finding federally and privately supported clinical trials for cancer.

CenterWatch. This website lists industry-sponsored clinical trials that are recruiting patients.

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