Understanding Prostate Cancer -- Diagnosis & Treatment
What Are the Treatments for Prostate Cancer? continued...
Radiation is often the main treatment for prostate cancer that has not spread. It may also be given as follow-up to surgery. Radiation may also be used, in advanced cases, to relieve pain from the spread of cancer to bones. Incontinence and impotence also occur with radiation. Radiation to the pelvis may also be done if PSA levels rise after surgery.
An advanced form of radiation, known as intensity modulated radiation therapy (IMRT), can increase the dose of radiation to the prostate with fewer side effects to the surrounding tissues. Proton beam therapy can increase the radiation dose to the prostate even more. But proton therapy has not been proven to be superior to IMRT. A more focused form of radiation, known as stereotactic radiation, is being used for early forms of prostate cancer. This treatment also has not been shown to improve the outcome of prostate cancer. Stereotactic radiation for prostate cancer is still new.
Radioactive seeds (brachytherapy) deliver radiation to the prostate with little damage to surrounding tissues. During the procedure, the tiny radioactive seeds, each like a grain of rice, are implanted in the prostate gland using ultrasound guidance. The implants remain in place permanently and become inactive after many months. In some patients, brachytherapy may be used with traditional radiation. In some patients, if the prostate gland is too large for brachytherapy, hormone therapy can shrink the prostate to allow brachytherapy to be done.
Hormone therapy is the recommended treatment for advanced prostate cancer. Since testosterone can make prostate cancer grow, hormone therapy works by tricking the body to stop making testosterone, thus stopping or slowing the cancer's growth. Even advanced cases that cannot be cured may be controlled for many years with hormone therapy. But there is a higher risk of heart disease with this treatment. Fractures are also a risk due to thinning of bone. Medications are given to reduce the risk of osteoporosis and fractures.
Testosterone can also be removed from the bloodstream by surgically removing the testicles (orchiectomy) or by giving female hormones such as estrogen or other drugs that block testosterone production. Estrogen therapy is no longer used routinely. Patients generally prefer the testosterone-blocking drug treatment because it is effective, less invasive, and causes fewer side effects than surgery or female hormone drugs.