Prostate Cancer, Advanced or Metastatic - Treatment Overview
The two most common surgeries are:
- Radical prostatectomy. This operation
takes out your prostate gland and the cancer in and around it.
- Transurethral resection of the prostate (TURP). This surgery can help relieve bladder problems, because it
removes part of the tumor that may be blocking the
urethra, the tube that carries urine from your bladder
through your penis. The procedure is done under
general anesthesia. This can keep the tumor from
growing for a while. But TURP does not take out the whole tumor.
Hormone therapy is also called androgen deprivation therapy (ADT). Prostate cancer needs male
hormones (testosterone) in order to survive. Hormone therapy
decreases the amount of testosterone and other male hormones in your body. This
often causes tumors to shrink. Shrinking the tumors can ease severe bone pain
caused by the spread of cancer to the bones. Hormone therapy usually is
combined with radiation therapy.
The most common methods are:
- LH-RH agonists and GnRH agonists. These drugs, such as
goserelin (Zoladex), leuprolide (Lupron), and triptorelin (Trelstar),
stop the body from making testosterone.
- GnRH antagonists. These drugs stop the body from making testosterone. They work right away and avoid the flare caused by GnRH agonists that can make symptoms worse for several weeks. One GnRH antagonist is degarelix (Firmagon).
- Antiandrogens. These drugs, such as bicalutamide
(Casodex), often are used along with LH-RH agonists. Antiandrogens help block
the body's supply of testosterone.
- Orchiectomy. This is surgery to remove
the testicles, which produce more than 90% of the body's male hormones (androgens), including testosterone.
In some cases, men will have radiation therapy after a
prostatectomy, especially if the tumor could not be completely removed by
Some men choose to start hormone therapy only after they
have symptoms. But many doctors recommend starting hormone therapy right away
if cancer is found in the
lymph nodes during surgery to remove the prostate. Early treatment may allow
men to live a little longer. Other doctors say to wait, because waiting delays
the bothersome and serious side effects of hormone therapy.