Within the realm of cancer treatment, a diverse group of healthcare experts, including medical oncologists, surgeons, and radiation oncologists, often collaborate to formulate a comprehensive treatment plan that can encompass a range of approaches to cancer care. After assessing an individual's prostate cancer condition, tailored treatment alternatives may encompass hormone therapy, immunotherapy, radiation therapy, and various other treatment options.
The selection of treatment methods and recommendations hinges on several factors, including the specific type and stage of the cancer, potential side effects, and the patient's personal preferences and overall health.
Common Prostate Cancer Treatment Options
- Observation or Active Surveillance
- Radiation Therapy
- Hormone Therapy
- Targeted Therapy
- Treatments for Prostate Cancer Spread to Bones
Observation Or Active Surveillance For Prostate Cancer
In some men, especially those with slow-growing cancer or the elderly, doctors may recommend observation (also called watchful waiting) or active surveillance.
- Active surveillance means that the cancer is closely monitored. Usually, this includes a prostate-specific antigen (PSA) blood test every 6 months and a digital rectal exam (DRE) at least once a year. In addition, prostate biopsies and imaging tests may also be done every 1 to 3 years.
- Observation (watchful waiting) describes a less intensive type of observation that may require fewer tests and rely more on changes in a man’s symptoms to decide if treatment is needed.
Surgery For Prostate Cancer
Surgery is commonly performed to try and cure prostate cancer if it is not thought to have spread outside the prostate gland.
The two main types of surgery include:
- a radical prostatectomy
- open or laparoscopic radical prostatectomy
This procedure is the most common type of surgery for prostate cancer nowadays. During this operation, the surgeon removes the entire prostate gland including some of the tissue around it, which includes the seminal vesicles.
Two types of radical prostatectomies are performed, namely:
- Laparoscopic radical prostatectomy, or a
- Robotic-assisted laparoscopic radical prostatectomy.
Both procedures carry risks, the two most common problems being:
- Erection problems, and
- Urinary incontinence
Laparoscopic Radical Prostatectomy (LRP)
For a laparoscopic radical prostatectomy (LRP), the surgeon inserts long instruments through several small incisions in the abdomen to remove the prostate.
The LRP procedure has about the same success rate as for open prostatectomies although the recovery times are much quicker.
Robotic-assisted Laparoscopic Radical Prostatectomy
This type of laparoscopic surgery is also known as a robotic prostatectomy. During this procedure, the surgeon uses robotic arms to operate through several small incisions in the patient’s abdomen.
This type of surgery allows the surgeon more manoeuvrability and more precision when moving the instruments than a standard LRP.
Robotic prostatectomy has advantages over the open approach in terms of less pain, blood loss, and recovery time. Side effects, such as urinary incontinence or erection problems, seem to occur equally between robotic prostatectomies and other surgeries.
Open or Laparoscopic Radical Prostatectomy
During this more traditional procedure, the surgeon operates through a single long skin incision (cut) to remove the prostate and nearby tissues. This type of surgery was more common in the past and is done less frequently nowadays.
Two types of open radical prostatectomies can be performed, namely:
- Radical retropubic prostatectomy, or a
- Radical perineal prostatectomy
Radical Retropubic Prostatectomy
For this open operation, the surgeon makes an incision in your lower abdomen, from the belly button down to the pubic bone. If tests indicate that the cancer might have spread to nearby lymph nodes, the surgeon may also remove some of these lymph nodes at this time.
Radical Perineal Prostatectomy
In this open operation, the surgeon makes an incision in the skin between the anus and scrotum (the perineum). This approach is used less often because it is more likely to lead to erection problems and because the nearby lymph nodes cannot be removed.
Radiation Therapy For Prostate Cancer
Radiation therapy uses high-energy rays to kill cancer cells. Depending on the stage and grade of the prostate cancer, radiation therapy might be used:
- As the first line of treatment for early or low-grade prostate cancer that is still contained in the prostate gland.
- As part of the first treatment (normally together with hormone therapy) for cancers that have grown outside the prostate gland.
- If the cancer is not removed completely removed during previous surgery or recurs.
- If the cancer is advanced, it helps keep the cancer under control and relieve symptoms.
Transurethral Resection Of The Prostate (TURP)
This operation is more often used to treat men with benign prostatic hyperplasia (BPH), which is a non-cancerous enlargement of the prostate. It is also occasionally used in patients with advanced prostate cancer to help relieve symptoms, such as trouble urinating.
Cryotherapy For Prostate Cancer
Cryotherapy (also called cryosurgery or cryoablation) is the use of very cold temperatures to freeze and kill prostate cancer cells as well as most of the prostate.
Cryotherapy may be an option to treat men with low-risk early-stage prostate cancer who cannot have surgery or radiation therapy.
Several types of hormone therapy can be used to treat prostate cancer. Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles.
When hormone therapy might be used
- If the cancer has spread too far to be cured by surgery or radiation
- If the cancer remains or comes back after treatment with surgery or radiation therapy
- Along with radiation therapy as the initial treatment
- To shrink the tumour before radiation to make treatment more effective
Chemotherapy for Prostate Cancer
Chemotherapy (chemo) uses anti-cancer drugs injected into your vein or given orally. These drugs travel through the bloodstream to target cancer cells in most parts of the body.
Chemo is mostly used when prostate cancer has spread outside the prostate gland and hormone therapy is not working.
Immunotherapy for Prostate Cancer
Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognise and destroy cancer cells more effectively. Various types of immunotherapy can be used to treat prostate cancer.
Sipuleucel-T (Provenge) is a cancer vaccine which boosts the immune system to help it attack prostate cancer cells.
Treatments for Prostate Cancer Spread to Bones
If the cancer has spread outside the prostate, preventing or slowing the spread of the cancer to the bones is a major objective of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment.
Bisphosphonates are drugs that work by slowing down bone cells called osteoclasts. They can be used:
- To help relieve pain and high calcium levels caused by cancer that has spread to the bones
- To help slow the growth of cancer that has spread to the bones and help delay or prevent fractures
- To help strengthen bones in men who are getting hormone therapy
Radiopharmaceuticals are drugs that contain radioactive elements. They are injected into a vein and settle in areas of damaged bones where they give off radiation that kills cancer cells.
Kyphoplasty is a minor surgery to stabilise a painful collapsed bone in a spine weakened by prostate cancer.
When properly prescribed, especially in terminal cancer patients, pain medicines are very effective and can vastly improve your quality of life.