Prostate Cancer

How Is Prostate Cancer Treated?

There are many treatments for prostate cancer. With new knowledge about prostate cancer and new treatment techniques, cure is possible for a large percentage of men with the disease. Treatments include:

• Watchful waiting
• Radiation therapy
• Chemotherapy
• Cryotherapy
• Hormone therapy
• Prostate removal
• TURP

Watchful Waiting

In watchful waiting, the prostate cancer is carefully monitored but is not immediately treated. This approach does not ignore prostate cancer but acknowledges that prostate cancer is generally slow growing.

In some cases, the cancer is growing so slowly that it most likely will not affect the man over the course of his lifetime. Watchful waiting may be preferable to aggressive treatment for men with other health problems or men over age 80.

If symptoms should develop or if the cancer should begin to spread more quickly, other treatments may be considered.

Radiation Therapy

Radiation can kill fast-growing cells such as cancer cells.Radiation therapy can be performed either externally or internally.

• External radiation therapy uses a beam sent from outside the body toward the tumor. Radiation therapy is performed at a hospital or treatment center, usually five days a week for several weeks. Radiation therapy is painless but may produce side effects that include tiredness, nausea, hair loss, skin soreness, and loss of appetite.
• Brachytherapy is an internal radiation therapy in which radioactive seeds or pellets are surgically implanted in the prostate using thin needles. An ultrasound picture guides physicians in placing the seeds. Medication can be given to block discomfort from the procedure.

This procedure, also called radioactive seed implant, allows for a higher total dose of radiation to a smaller area than is possible with external treatment. Men may stay in the hospital for a short time for implant radiation. The length of time that the implant is left in place depends on the amount of radioactivity needed for effective treatment. Once the implant is removed, no radioactivity remains in the body.

For further information about radiation therapy, go to Radiation Therapy.

Chemotherapy

Chemotherapy uses chemicals to kill cancer cells. It is used only when the cancer has spread beyond the prostate, not for early prostate cancer. The drugs used in chemotherapy are administered on an outpatient basis and do not require a hospital stay. Side effects may include fatigue, nausea, and hair loss.

Cryotherapy

In cryotherapy, an ultrasound probe is inserted into the rectum to produce a picture that the physician will watch on a monitor. The physician will insert probes into the prostate through small incisions between the rectum and scrotum. These probes deliver liquid nitrogen to the prostate, which freezes the tissue and kills cancer cells.

Cryosurgery is an effective way to treat small areas of cancer. Risks of the procedure include injury to the bladder. Men also may experience temporary swelling in the penis and scrotum.

Hormone Therapy

Because prostate cancer feeds on the male hormone testosterone, reducing testosterone will slow the growth of cancer. There are several ways to do this:

• The female hormone, estrogen, may be taken as a pill to counteract the effects of testosterone. This may cause breast tenderness and the growth of breast tissue, which will subside when treatment is stopped.
• Luteinizing hormone-releasing hormone agonists (LH-RH agonistss) are drugs that reduce the production of testosterone. LH-RH agonists can stop the production of testosterone without some of the side effects of estrogen. LH-RH is often used with hormones called antiandrogens, which aim at stopping testosterone from interacting with cancer cells.
• The removal of the testicles prevents the production of testosterone, a hormone known to increase the growth rate of prostate cancer. This procedure is known as orchiectomy.

Prostate Removal

If cancer has not spread beyond the prostate, removing the prostate (prostatectomy) offers an excellent chance of cure. However, time may need to pass following surgery to be certain that the microscopic cancerous cells have not metastasized (spread).

• In a suprapubic prostatectomy, the prostate is removed through an incision in the abdomen.
• In a perineal prostatectomy, the prostate is removed through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.

The two main side effects of prostate removal are:

• The possibility of urinary incontinence because of damage to the muscles that control urine flow
• Impotence (the inability to have an erection)

However, techniques for performing a prostatectomy are improving, and more healthy tissue can now be preserved. Nerve-sparing surgical techniques can preserve the nerve endings that control erection and can help avoid impotence.

For further information about prostate removal, go to Prostate Removal.

TURP

A procedure called transurethral resection of the prostate (TURP) removes just a portion of the prostate, with an instrument that is inserted through the urethra. The cancer is removed from the prostate by electricity that passes through the end of this special instrument.

This procedure can be helpful for:

• Men who cannot have a prostatectomy because of health factors or other reasons
• Men who just need to have a freer urine flow because an enlarged or cancerous prostate is constricting the urethra