Prostate Cancer Health Center

Prostate cancer is often curable. More than 90% of new cases of prostate cancer are caught early. Almost 100% of men with these early cancers survive 5 years or more after being diagnosed.¹

Choosing treatment for prostate cancer can be confusing. Any treatment can cause serious side effects.

The main choices for treating prostate cancer include surgery to remove the prostate gland (prostatectomy), radiation, cryosurgery, hormone therapy, and active surveillance (watchful waiting).

Active surveillance may be a good option if you have cancer that is low-risk and has not spread (early stage). With active surveillance, you will have regular checkups with your doctor to see if your cancer has changed.

Active surveillance may also be a good option if you are an older man with serious health problems or close to the end of your life. If this is true in your case, you may not want to have any treatment to remove the cancer. You may decide to have treatment only if it is needed to keep you comfortable (palliative care).

Active surveillance allows a man to wait or avoid treatments that may have serious side effects. But a man who has cancer that is more likely to spread will need to have other treatments such as surgery or radiation unless he is expected to live only a short time.

Your treatment decision will depend on:

• Your age.
• Any serious health problems, including any urinary, bowel, or sexual function problems.
• Your PSA level.
• What kind of cancer cells you have. This is called the grade or Gleason score of your cancer. Most prostate cancer cells grow very slowly, but some types of cells grow quickly and spread to other areas of the body.
• How far your cancer has spread. This is called the stage of your cancer.
• The side effects of treatment.
• Your personal feelings and concerns.

Prostate cancer may be curable if it is detected and treated early. Unlike many other cancers, it is usually slow-growing. For most men, this slow growth means they have time to learn all they can before deciding whether to have treatment or which treatment to have.

Initial treatment

The main choices for treating prostate cancer include active surveillance, prostatectomy, radiation, cryosurgery, and hormone therapy.

• Active surveillance is a treatment choice for any man who has low-risk cancer that has not spread (early stage). Or it can be a treatment choice for a man who is close to the end of his life.
• Surgery involves removing the cancer by removing the prostate gland. This operation is called a prostatectomy. Before removing the prostate, the surgeon may remove some lymph nodes in the area to see if the cancer has spread.
  • Nerve-sparing surgery helps preserve the nerves that are along the side of the prostate and that are needed for an erection. This surgery is only done when there is little chance of leaving cancer cells behind. If you already have sexual function issues, nerve-sparing surgery may not be the best choice for you.
  • Laparoscopic radical prostatectomy is surgery done through several very small incisions in the belly. Laparoscopic surgery is done with a tiny camera and special instruments to remove the prostate.
  • Robotic-assisted laparoscopic radical prostatectomy is surgery done through small incisions in the belly with robotic arms that translate the surgeon's hand motions into finer and more precise movements. This surgery requires specially trained doctors.
• Radiation treatments, which include external and internal radiation, have been improved with newer technologies that reduce side effects and other problems caused by radiation in the past.
  • External radiation. Also called external beam radiotherapy, or EBRT, radiation therapy uses high-energy rays, such as X-rays, to destroy the cancer. It is usually given in multiple doses over several weeks. Radiation destroys tissue, so it may damage the nerves along the side of the prostate that affect your ability to have an erection. If you already have bowel problems, external radiation may make your symptoms worse. The two most common forms of external radiation are listed here:
    • Conformal radiotherapy (3D-CRT) uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
    • Intensity-modulated radiation therapy (IMRT) uses newer 3D-CRT technology to target the cancer.
  • Internal radiation (brachytherapy). Brachytherapy is a one-time radiation treatment that uses tiny radioactive seeds. After you are given anesthesia, the doctor uses a needle to inject the seeds into your prostate, where they slowly release radiation directly into the cancer. Sometimes external radiation or hormone therapy is added to brachytherapy. If you already have urinary problems, brachytherapy may make your symptoms worse.
    • High-dose rate brachytherapy (HDR brachytherapy). For this form of brachytherapy, radioactive material is placed into the prostate for a very brief period of time (seconds to minutes) and then removed. The radiation is delivered this way several times. Early results from studies show that HDR brachytherapy is as helpful as other kinds of internal radiation.⁷
• Cryosurgery, also called cryoablation, freezes the prostate gland to kill the cancer. This is often done when surgery is not an option and when the cancer is advanced but still inside the prostate gland. And the results, including side effects such as incontinence or an injury to the rectum, depend very much on the doctor's skill and experience. With cryosurgery, the prostate gland is not removed.
• Hormone therapy, also called androgen deprivation therapy or (ADT), is used in most cases with either surgery or radiation. Hormone therapy cannot cure prostate cancer. But it will usually shrink the tumor and slow the rate of cancer growth, sometimes for years. Taking a hormone-therapy medicine lowers your level of testosterone and other male hormones. Another way to lower male hormones is by having surgery to remove the testicles, called an orchiectomy.