Options Vary for Prostate Cancer Treatment

Since prostate cancer frequently progresses very slowly, active surveillance is a frequent treatment option, but where necessary, surgery, radiation therapy, hormone therapy, and chemotherapy can be used.

Prostate cancer is a complex disease, and treatment varies from patient to patient. Therapy recommendations can depend on age, stage and grade of the cancer, preexisting health conditions, and possible treatment side effects. Treatment approaches can include active surveillance, surgery, radiation therapy, hormone therapy, chemotherapy, or a combination of these. Consulting with doctors who specialize in different forms of treatment, such as urologists, radiation oncologists, and medical oncologists, can help patients understand their treatment options so they can make an informed decision.

Prostate cancer often progresses very slowly and, in these cases, less aggressive forms of treatment are generally recommended. Active surveillance, also known as expectant management and watchful waiting, is often the first step for men with early stage prostate cancer, men with other serious health conditions, and older men. This approach includes close monitoring through prostate-specific antigen blood tests, digital rectal exams, and ultrasounds every 3 to 6 months to determine whether the cancer is advancing. When tests indicate that the cancer is spreading or becoming more aggressive, more advanced forms of treatment are recommended.

Active surveillance allows men with less serious cases to avoid side effects that accompany aggressive treatment. However, there is always a chance that the cancer will spread, limiting treatment options and possibly affecting one’s chances for survival. Some patients may be uncomfortable with this approach and may opt for other forms of treatment, despite possible side effects.

In cases where prostate cancer has not spread beyond the glands, the cancer is usually treated with surgery. The most common surgical approach is radical prostatectomy, in which the entire prostate gland and some surrounding tissue are removed. Side effects can include urinary incontinence, erectile dysfunction, and sterilization.

Radiation therapy is often used in cases of low-grade cancer, in cases where the cancer has spread beyond the prostate, and after surgery in cases where the cancer is not completely removed or comes back. Side effects for radiation are similar to those for surgery and include urination problems, rectal problems, and urinary incontinence.

Hormone therapy, which stops the production of testosterone, is a treatment option for men with advanced prostate cancer. Because prostate cancer cells use testosterone to grow, halting the production of the hormone may cause cancer cells to die or grow more slowly, potentially shrinking or slowing the growth of tumors. Hormone therapy can make radiation more successful or can be used to remove any remaining cancer cells after surgery. Side effects can include erectile dysfunction, hot flashes, loss of bone mass, weight gain, and loss of sex drive.

If hormone therapy is unsuccessful, or if the cancer spreads to remote parts of the body, chemotherapy is generally used. Side effects, which are often short-term, include hair loss, mouth sores, nausea and vomiting, loss of appetite, diarrhea, and fatigue.