Prostate Cancer - Treatment Overview
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
Choosing treatment for
prostate cancer can be confusing. Any treatment can cause serious side
The main choices for treating prostate cancer include
surgery to remove the prostate gland (prostatectomy),
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
- Your age.
- Any serious health problems, including any
urinary, bowel, or sexual function problems.
- 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
- 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.
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
- 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
- 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