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Prostate cancer - treatment

Description

Treatment for your prostate cancer is chosen after a thorough evaluation. Your doctor will discuss the benefits and risks of each treatment.

Sometimes your doctor may recommend one treatment for you because of your type of cancer and risk factors. Other times, your doctor will talk with you about two or more treatments that could be good for you.

Factors you and your doctor must think about include:

  • Your age and other medical problems you 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
  • Your prostate-specific antigen (PSA) test result

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
  • How likely it is that you will have different side effects and how they will affect your life

Radical prostatectomy (prostate removal)

Radical prostatectomy is surgery to remove the prostate and some of the surrounding tissue. It is an option when the cancer has not spread beyond the prostate gland.

Healthy men who will likely live 10 or more years after being diagnosed with prostate cancer often have this procedure.

Be aware that it is not always possible to know for certain before surgery if the cancer has spread beyond the prostate gland.

Possible problems after surgery include difficulty controlling urine and erection problems.

Radiation therapy

Radiation therapy works best for treating prostate cancer that has not spread outside of the prostate. It may also be used after surgery if there is a risk that cancer cells are still 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. Treatment is usually 5 days a week and lasts 6 to 8 weeks.
  • Before treatment, the radiation therapist uses a special pen to mark the part of the body that is to be treated.
  • Radiation is delivered to the prostate gland using a machine similar to a regular x-ray machine. The treatment itself is usually painless.

Side effects may include:

  • Appetite loss
  • Diarrhea
  • Erection problems
  • Fatigue
  • Rectal burning or injury
  • Skin reactions
  • Urinary incontinence, urgency, or blood in urine

There are reports of secondary cancers arising from the radiation as well.

Proton therapy is another kind of radiation therapy used to treat prostate cancer. Proton beams target the tumor precisely, so there is less damage to the surrounding tissue. This therapy is not widely accepted or used.

Prostate brachytherapy

Brachytherapy is often used for small prostate cancers that are found early and are slow-growing. Brachytherapy may be combined with external beam radiation therapy for more advanced cancers.

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 do not feel them.
  • The seeds are placed permanently.

Side effects may include:

  • Pain, swelling, or bruising in the penis or scrotum
  • Red-brown urine or semen
  • Impotence
  • Incontinence
  • Urinary retention
  • Diarrhea

Hormonal therapy

Testosterone is the body's main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is treatment that decreases the effect of testosterone on prostate cancer.

Hormone therapy is mainly used for cancer that has spread beyond the prostate. The treatment can help relieve symptoms and prevent further growth and spread of cancer. But it does not cure the cancer.

The main type of hormone therapy is called a luteinizing hormone-releasing hormones (LH-RH) agonist:

  • The medicine blocks the testicles from making testosterone. The drugs must be given by injection, usually every 3 to 6 months.
  • Possible side effects include nausea and vomiting, hot flashes, anemia, fatigue, osteoporosis, reduced sexual desire, decreased muscle mass, weight gain, and impotence.

The other type of hormone medicine is called an androgen-blocking drug:

  • It is often given along with LH-RH drugs to block the effect of testosterone produced by the adrenal glands, which make a small amount of testosterone.
  • Possible side effects include erection problems, reduced sexual desire, liver problems, diarrhea, and enlarged breasts.

Much of the body's testosterone is made by the testes. As a result, surgery to remove of the testes (called orchiectomy) can also be used as a hormonal treatment.

Chemotherapy

Chemotherapy and immunotherapy (medicine that helps the body's immune system fight the cancer) may be used to treat prostate cancer that no longer responds to hormone treatment. Usually a single drug or a combination of drugs is recommended.

References

National Cancer Institute: PDQ Prostate Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified 11/19/2013. Available at http://cancer.gov/cancertopics/pdq/treatment/prostate/HealthProfessional. Accessed January 12, 2014.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate cancer. Version 1. 2014. Available at http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed January 12, 2014.

Nelson WG, Carter HB, DeWeese TL, et el. Prostate cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 84.


Review Date: 1/12/2014
Reviewed By: Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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