Knowing your age, medical history, and the stage of the cancer, your oncologist along with a group of physicians will determine the most effective treatment to combat the disease. Most of the times, a combination of therapies are used to increase chances of recovery. The main treatments for prostate cancer are surgery, cryosurgery, chemotherapy, radiotherapy, and hormonal therapy. In some cases, you may be recommended a watchful waiting (also known as expectant therapy, observation or deferred therapy).
In case the cancer cells are confined to the prostate gland, your doctor may suggest a program of close monitoring, including analysis of your PSA and periodic clinical examinations; no medication or surgery will be recommended. This technique is safe in an early phase of prostate cancer, as the development of prostate cancer is often slow.
Your oncologist may also recommend you a watchful waiting if you are elderly; because in most cases, the tumor will not have time to grow before other health problems do occur. It is, therefore, better to observe the cancer without performing any surgery, which can lead to major complications. In fact, in elderly patients, the cancer treatment may cause more problems than the cancer itself.
Surgery can be performed in some cases of prostate cancer. In general, your surgeon will perform surgery if the cancerous cells have not spread into other distant sites of your body; in this case, your surgeon will remove the tumor from your body by removing the prostate, totally or partially. If the tumor is very large, your surgeon may decide not to proceed with surgery to avoid very serious damages to your nervous system.
Radical prostatectomy – also called radical retropubic prostatectomy, radical prostatectomy is a surgical procedure involving removal of the entire prostate gland and, sometimes, the seminal vesicles. In general, radical prostatectomy is performed under general spinal or epidural anesthesia. This surgical intervention cannot be performed if the cancer exceeds the limits of the prostate gland. A radical retropubic prostatectomy often requires blood transfusion.
Some patients can have good results from radical retropubic prostatectomy; however, about 10% of patients with a localized prostate cancer will develop local recurrence within 5 years following the surgery. In addition, radical retropubic prostatectomy tends to cause complications such as urinary incontinence and impotence.
Transurethral resection of the prostate (TURP) – this procedure is usually performed in cases of benign prostatic hyperplasia. In the treatment of prostate cancer, it is used as a palliative treatment for urinary problems due to obstruction of the urinary tract caused by the disease. The operation can bring an improvement; however, it should be associated with an appropriate treatment to prevent recurrence of the obstruction.
Laparoscopic Robotic Assisted Prostatectomy – also known as robotic prostatectomy, this is a new form of surgery performed with the assistance of a surgical robot. During the procedure, there is no direct contact with you and your surgeon. The surgeon sits in another place (room), but able to view and control the procedure using a camera with the binocular Insite vision system. According to U-M Health System group, the goal of the robotic prostatectomy is to:
- excise the cancer completely;
- provide good urinary continence post-operatively;
- Maintain ability to have erections after the surgery (if present before the surgery).
Radiation Therapy (Radiotherapy)
Radiation therapy is a local regional treatment practiced to destroy cancer cells using high-powered X-rays. Unlike chemotherapy, it does not damage surrounding healthy tissue. In general, radiotherapy is used to treat cancers that are localized to the prostate gland, or prostate cancers that has spread into the surrounding tissues only. It can be used to reduce the volume of the tumor and/or to prevent local complications. Your oncologist may recommend external beam radiation or internal radiation therapy (brachytherapy).
- External radiation – in this form of radiotherapy, high-energy rays come from outside the body and focus on the prostate and some surrounding tissues. The radiotherapy specialist will use very specific dosage so that the radiation is concentrated on the diseased tissue and sparing neighboring organs. In some cases, the volume to be irradiated may be limited to the prostate or spread to regional lymph nodes. In general, the treatment is painless and somewhat similar to an ordinary x-ray. The therapy involves one session per day5, 5 days a week for 7 to 8 weeks.
Side effect may include: Urinary problems (temporary), rectal urgency, loose stools, rectal bleeding, discomfort during bowel movements, and erectile dysfunction.
- Internal radiotherapy – also called brachytherapy, internal radiotherapy involves implanting dozens of rice-sized radioactive seeds into the prostate in order to destroy the cancer cells. Their installation is performed under general or epidural anesthesia and lasts 1 h 30 to 2 hours. The radioactive seeds can remain in your prostate gland for months; however, their radioactivity decreases with time and virtually useless after six months. Although brachytherapy requires a short hospitalization, most patients go home the day of the procedure.
Brachytherapy is practiced to treat small or moderate-sized tumor. In addition, it is recommended that you stay at least six feet away from children and pregnant women after the treatment. After treatment, you may experience erectile dysfunction and burning while urinating.
Prostate Cancer Chemotherapy
Chemotherapy is the most common form of cancer treatment. Unlike surgery and radiotherapy, it can be used to treat noninvasive prostate cancer and advanced prostate cancer for which surgery can’t be performed. Chemotherapy involves using powerful chemicals to kill cancer cells or prevent them reproducing. Unlike surgery, chemotherapy is a systemic treatment that affects your whole body. That is, the drugs are designed to destroy cancer cells throughout your body. Chemotherapy drugs can be given in many ways:
- injection (the most common)
- intra-arterial (IA)
- intraperitoneal (IP)
- intravenous (IV)
- Orally (taken by mouth).
Chemotherapy Side effects – by attacking cancer cells, the chemotherapy drugs affect healthy cells that divide rapidly, which often causes side effects. Side effects vary from one patient to another and from drug to another. The most common chemotherapy side effects include:
- hair loss
- loss of appetite
- abdominal pain
- Sore mouth
- feeling sick
- Flu-like symptoms: chills, fever, muscle aches, etc.
Hormone therapy consists of using medications capable of depriving cancer cells of male hormones they need to multiply. Hormone treatment is performed if the cancer has spread beyond the prostate gland or has recurred after other treatments. Your oncologist may use hormone therapy to treat cancer localized to the prostate in order to reduce the volume of the prostate gland to make possible a surgical intervention or a radiotherapy. In addition, if you are very old, your doctor may recommend hormone therapy as a palliative treatment to improve your life.
Hormone therapy drugs commonly used to treat prostate cancer include:
- leuprolide (Lupron, Viadur)
- goserelin (Zoladex)
- bicalutamide (Casodex)
- nilutamide (Nilandron)
Hormone therapy medications can cause a variety of side effects:
- liver damage
- hot flashes
- weight gain
- breast enlargement
- Reduction in muscle and bone mass.