Your team of doctors will help you decide which prostate cancer treatment is the best, most effective option for you. Each treatment has its benefits, risks and impacts on quality of life. Several treatments are very successful in providing a cure or keeping the cancer under control for many years. Most men with prostate cancer are living testimony to this.
Some prostate cancers grow quickly and spread — or metastasize — to other parts of the body. If unchecked, these cancers can be fatal. Most prostate cancers, however, are slow growing and in many cases, immediate treatment isn't necessary. Many men take several months to decide what to do. The decision can be complicated. You should consider the pros and cons of the various treatments, get second opinions and decide what is best for you, all of which may take time.
The right treatment for you may depend on a number of factors including:
Determining if your cancer is confined to the prostate is key in choosing a treatment. If the cancer is confined to the prostate, you may consider a localized treatment that attempts a cure. If the cancer has spread — to nearby lymph nodes or more distantly to bones or other organs — then the goal of treatment may be to control the cancer rather than cure it.
No matter which treatment or combination of treatments you and your doctor choose, your PSA should be monitored regularly. Here are some of the treatment options for prostate cancer:
Some prostate cancer patients don't pursue any active treatment and instead use a "watch and wait" approach, also known as active surveillance, which involves extensive monitoring. This may be recommended if the cancer is very small and confined to one area of the prostate; is expected to grow very slowly; or if the patient is elderly, frail or has other serious health problems. Since prostate cancer tends to grow very slowly, older men with the disease may never need treatment. Younger patients, or those with a life expectancy greater than 10 years, may need a more aggressive approach. The best candidates for this regimen are those with small, low grade cancers associated with low and stable PSA levels.
Some men, however, may decide that the side effects of more aggressive treatments outweigh the benefits and they turn to alternative therapies to slow cancer development. In these cases, close monitoring is critical so if the cancer develops into a more serious form, it is immediately detected.
More than 500 patients at the UCSF Prostate Cancer Center have chosen active surveillance. About one in five on active surveillance receive treatment two to three years after diagnosis, after a change is detected such as a rapidly rising PSA level or increased tumor size.
At UCSF, men on active surveillance have PSA levels checked every three to fourth months, prostate ultrasounds every six to nine months and prostate biopsies after one year of active surveillance, then again every one to two years.
Listen to an audio interview with Dr. Peter Carroll about this topic.
Chemotherapy drugs are commonly used to treat many different cancers. They kill cancer cells directly, usually by disrupting the reproductive cycle of those cells. Chemotherapy usually is used with patients whose prostate cancer has metastasized outside the prostate and for whom hormone therapy has failed.
In the past, chemotherapy has shown only limited effectiveness in treating advanced prostate cancer. More recently, new developments in this approach — such as giving two or more drugs together, using newly developed chemotherapy agents, and combining chemotherapy with hormone therapy — have significantly improved treatment outcomes.
Cryosurgery, used to treat localized prostate cancer, kills the cancer cells in the prostate by freezing them. Probes containing liquid nitrogen are inserted into the prostate and maneuvered using ultrasound to destroy prostate tissue. This method has shown good results in treating cancer confined to the prostate, but is only offered at a limited number of medical centers around the country.
Some doctors believe that the entire prostate must be frozen, which impacts the nerve bundles on the sides of the gland. Impotence almost always results from cryosurgery when the entire gland is treated. Urinary incontinence also may occur. Some doctors are performing "nerve-sparing" cryotherapy, where only the cancerous area of the prostate is treated. This is often used for men who have failed other therapies, such as radiation therapy.
Prostate cancer cells usually require testosterone — the main male hormone or androgen — to grow. Lowering androgen levels with hormone therapy can stop or slow cancer growth. Hormone therapy may control the cancer, often for a number of years, but it is not a cure. Usually, the cancer will change over time into a form that no longer needs testosterone to grow, called androgen independent, at which point other treatments are considered.
Most prostate cancers are very responsive to hormone therapy when first diagnosed and it is usually recommended as the initial treatment for advanced cancers, including prostate cancers that have metastasized or spread. Hormone therapy does have significant side effects, such as a decrease in sexual desire and some level of erectile dysfunction. The decision to undergo this therapy should be considered carefully.
In this approach, also called intermittent androgen blockade, a patient is placed on hormone therapy for a period of some months to a year or more. After the patient's PSA level has dropped close to zero and remains at this level, the hormone therapy is stopped. When the PSA rises to a certain level following the return of testosterone production, the hormone therapy is resumed.
The length of time that a man can stay off treatment may range from several months to well over a year. The intermittent approach may reduce some of the side effects of hormone therapy, improve quality of life and allow some men to regain their sexual interest and potency during the off period.
This method is regarded as experimental. Studies are being conducted to compare its effectiveness with continuous hormone therapy and to determine if it delays androgen independence.
Radiation therapy uses high-energy rays and particles to kill cancer cells. The two main types are external beam radiation therapy (EBRT) and brachytherapy.
Radiation, usually in the form of X-rays, is focused from a source outside the body onto the area affected by cancer. After imaging studies are done to locate the cancer, treatment is designed to guide where the radiation beams will be directed. Marks are placed on the patient's skin to help position the patient for treatment. Patients are treated five days per week over a period of seven to eight weeks, with each treatment lasting only a few minutes. Patients return home after each treatment and no hospital stay is required.
There are two forms of this treatment — permanent and temporary.
For more information, please see our FAQ on Radiation Therapy for Prostate Cancer.
A radical prostatectomy removes the entire prostate gland and some surrounding tissue. Usually, it is performed when the cancer has not spread far outside the gland. The surgery is done under general anesthesia, generally takes two to four hours and requires a hospital stay of one to two days. Prostatectomies have been performed successfully for many years. In the past, these procedures were regarded as the "gold standard" although other techniques have yielded similarly good results.
There is still no guarantee, however, that the cancer will not return. Some cancers are found to be more extensive or aggressive than believed before surgery, indicating a higher risk for cancer recurrence. The value of the procedure is that the primary tumor is removed and more accurate staging of the cancer can be done.
Here are the main types of radical prostatectomy:
Research has increased our overall understanding of prostate cancer and new treatments are being tested in patients. Clinical trials primarily involve patients who have rising PSAs after treatment or who have more advanced, metastatic cancers. A number of new agents may eventually provide more treatment options for new and recurring cancers. But at this time, none of them are regarded as cures, or even as replacements for surgery, radiation or hormone therapy.
Generally, patients being treated with these new approaches have experienced fewer side effects than patients receiving more traditional treatments.
Alternative and complementary therapies are treatments that fall outside conventional medicine in this country. Their effectiveness for treating cancer is, as yet, unproven. The field of alternative and complementary medicine is very broad and encompasses changes in diet and lifestyle, stress reduction, acupuncture, homeopathy and other approaches.
Tell your doctor if you are using any complementary or alternative therapies. Many of these therapies may benefit patients by helping them lead more healthy and active lives, reducing emotional stress associated with prostate cancer and its treatment, and reducing pain and discomfort. The main treatments include:
Reviewed by health care specialists at UCSF Medical Center.