There's no single option that’s right for every man with prostate cancer. Some tumors grow very slowly or not at all, so you may never need treatment. Others grow faster and spread to different places in your body. In either case, you and your doctor will work together to decide what's best for you.
The treatment you need will depend on a few things:
- Your age, health, and lifestyle
- How serious your prostate cancer is (how large the tumor is and if it has spread in your body)
- Your thoughts (and your doctor’s opinion) about if you need to treat the cancer right away
- Possible side effects
- The chance that a treatment will help or cure your cancer
The most common prostate cancer treatments are:
Watchful waiting. If you have a small, slow-growing tumor, you and your doctor may decide to wait until you have symptoms to initiate treatment.
Active surveillance, you may have regular PSA (prostate-specific antigen) blood tests, rectal exams, ultrasounds, and biopsies to see if the cancer is getting worse. If it starts to grow or spread, you can explore other treatments.
Surgery. It’s an option if you're healthy and your cancer hasn't spread. There are several types. Your doctor may only remove your prostate gland. Or they might take it and the tissue around it. The most common side effects from an operation are problems controlling your urine and trouble getting and keeping an erection. Sometimes they go away on their own after surgery, especially bladder control issues. Talk to your surgeon beforehand to see if they think they'll be able to protect the nerves around your prostate to prevent these side effects.
Radiation therapy. This treatment uses high-energy beams (similar to X-rays) to kill the cancer. It's often a choice for older men and for those with other health problems. You also might have it after surgery to get rid of any cancer cells left behind. It also helps for cancer that has spread to the bone. There are two types of radiation:
- External: A machine outside your body directs rays at the cancer.
- Internal (brachytherapy): A doctor does surgery to place small radioactive "seeds" into or near the cancer.
Sometimes, a mix of both treatments works best.
Hormone therapy. Prostate cancer cells need male sex hormones, like testosterone, to keep growing. This treatment keeps the cancer cells from getting them. Your doctor might call it androgen deprivation therapy. Some hormone treatments lower the levels of testosterone and other male hormones. Other types block the way those hormones work.
Cryotherapy. If you have early prostate cancer, your doctor might choose to kill cancer cells by freezing them. They’ll put small needles or probes into your prostate to deliver very cold gasses that destroy the cells. You doctor may suggest whole gland cryosurgery for low- and intermediate-risk localized prostate cancer patients who are not suitable for either radical prostatectomy or radiotherapy.
It’s hard to say for sure how well it works. Scientists haven’t done much long-term research that focuses on using it to treat prostate cancer. It's usually not the first treatment option a doctor recommends.
Chemotherapy. This treatment uses drugs to shrink or kill prostate cancer cells. You can take the drugs by mouth or have them injected into your bloodstream. Most men with early prostate cancer don’t get chemo. It’s usually only for advanced cases or when the cancer has spread to other parts of the body.
Cancer vaccine. Most work by boosting your body's defenses so it can fight an infection. The prostate cancer vaccine gets your immune system to attack cancer cells. This treatment works best if you’ve tried hormone therapy and it isn't working anymore. The vaccine is custom-made for you. Scientists don’t know if it stops or slows down the cancer’s growth, but it does seem to help men live longer with prostate cancer.
Bone-directed treatment. If the cancer reaches your bones, drugs called bisphosphonates can help ease pain and prevent breaks. Your doctor may also suggest a medication given in your veins that sends radiation directly to bones.
High-intensity focused ultrasound. This device produces sound waves that deliver heat energy to kill cancer cells. It’s unclear how well it works as it hasn’t yet been compared with other standard prostate cancer treatments.
Proton Beam Therapy: This uses a beam of protons to irradiate diseased tissue. It is another option for treatment of localized prostate cancer, but it offers no real advantage over other forms of definitive treatment.
You may start with one of these treatments and change it, or your doctor might mix different treatments. You’ll work together to find the best plan.