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Treating Prostate
Cancer

Fight Back with the Best Treatment Plan


Your fight against prostate cancer is personal and should be treated as such. What works for someone else might not be the best option for you. Luckily, very few prostate cancers require urgent treatment. If that’s the case for you, it’s good to know all of your options, including new prostate cancer treatments and technologies. Cancer treatments are performed by a variety of different doctors, such as surgeons and radiation oncologists. Be sure to research doctors with substantial experience, and discuss everything in detail so that you have confidence in your decision and a strong and supportive team around you. You may also want to seek a second opinion to ensure your plan fits your lifestyle and health needs.

Discuss Your Prostate Cancer Treatment Options

A prostate cancer diagnosis can be overwhelming, especially if you don’t know what topics to talk about with your doctor. Below are some initial talking points to help you get the answers you need to feel comfortable about your treatment plan.

  • Pros and cons of treatment options
  • Side-effects of treatment
  • Possible treatment outcomes
  • Treatment center technologies and procedures
  • Your short- and long-term goals
  • Grade and stage of your prostate cancer Learn More
  • Your age and expected life span
  • Other serious health issues (heart disease, high blood pressure, poorly controlled diabetes)
  • Your need to treat your cancer immediately
  • Possible scenarios if you choose to postpone treatment
  • The chances of your cancer returning

Common Prostate Cancer Treatments Available

With new technologies and advancements improving our ability to treat cancer, there’s no longer one answer to the question, “What is the best treatment for prostate cancer?” Every case is different, and options vary based on stage, diagnosis, personal health and lifestyle. Most treatment plans also involve a combination of treatments to cure cancer and prolong and/or improve the quality of life. Treatment centers offer different and newer technologies and procedures with every option, so it’s important to educate yourself on what’s available.  Discover prostate cancer treatment pros and cons for the following treatments:

Active Surveillance
Surgery
Radiation (Standard X-ray Radiation, Proton Therapy, and Brachytherapy)
Drug Therapy
Cryotherapy
New Treatment

Active Surveillance for Prostate Cancer

Also known as “watchful waiting,” active surveillance is a non-treatment option that involves continued monitoring of prostate cancer. More frequent checkups (biannual or quarterly) are often required to keep an eye on any changes through PSA blood tests, Digital Rectal Exams (DREs) and ultrasounds. Biopsies may also be done to assess the aggressiveness of the cancer and its risk of growing and spreading. Studies have found that, after 15 years on active surveillance, less than 1% of men developed a metastatic disease. Additionally, over 30% of men have prostate cancers so slow-growing that non-treatment may be a better option.

Often Recommended for:

  • < 10 PSA level
  • < 6 Gleason score
  • Experiencing no noticeable symptoms
  • Stage 1 prostate cancer
  • Older men or those with other serious health problems
  • < 10-year life expectancy

Possible Side Effects of Active Surveillance:

  • No treatment-related side effects

Pros & Cons of Active Surveillance for Prostate Cancer

Pros:

  • No surgery or hospital stays
  • New technologies continue to improve imaging and testing

Cons:

  • Frequent checkups for testing and biopsies
  • May face a greater risk of prostate cancer growing and spreading
  • Stage of your prostate cancer may advance
  • May limit future treatment options and chances of curing the cancer
  • Diagnosis can create stress and anxiety

Surgery Treatment Options for Prostate Cancer

If your cancer has not spread outside of the prostate, surgery to remove your prostate gland is a common choice to try and cure prostate cancer. There are a few different options available, including open radical prostatectomy and laparoscopic radical prostatectomy. TURP is also a non-curative approach used in men with advanced prostate cancer to help relieve symptoms. Post-operations are relatively the same. After surgery, a thin, flexible tube known as a catheter will be put in your penis to help drain your bladder for 1 to 2 weeks while you heal and regain bladder control. Typical recovery time involves a multiday hospital stay and activity limitations for a couple of months.

Open Radical Prostatectomy for Prostate Cancer

During a radical retropubic prostatectomy, an incision is made in the lower abdomen to remove the entire prostate gland, some tissues and/or seminal vesicles. If there is a reasonable chance the cancer has spread outside of the prostate, your surgeon may perform a lymph node biopsy to test the area before continuing with the surgery as it’s unlikely it can be cured with surgery alone and the removal of the prostate could lead to other serious side effects. In a radical perineal prostatectomy operation, your surgeon will make an incision between the anus and scrotum to access the prostate. While this operation is shorter, may result in less pain and is an easier recovery, it’s more likely to lead to erection problems.

Often Recommended for:

  • Stage 1 or stage 2 prostate cancer

Possible Side Effects of Open Radical Prostatectomy:

  • Erectile dysfunction or sexual impotence
  • Urinary incontinence
  • Changes in orgasm
  • Loss of fertility
  • Lymphedema (rare complication from removing too many lymph nodes, causing painful fluid buildup but usually treatable with physical therapy)
  • Changes in penis length (due to a shortening of the urethra)

Pros & Cons of Open Radical Prostatectomy for Prostate Cancer

Pros:

  • Can be a curative option
  • Nerve-saving approach may help prevent impotence
  • Removed tissue helps accurately stage cancer

Cons:

  • Cancer in nearby lymph nodes most likely can’t be removed
  • Prostate gland may not be removed if cancer has spread
  • Surgical risks (reactions to anesthesia, bleeding or blood clots in legs or lungs, damage to nearby organs and Infections in the surgery site)
  • Longer recovery times and activity restrictions

Laparoscopic Radical Prostatectomy (LRP) for Prostate Cancer

During this operation, your surgeon will insert a special instrument through several small incisions in the abdomen to remove the prostate. The instrument has a small video camera on the end so that your surgeon can see inside the body. Many surgeons perform a robotic-assisted laparoscopic radical prostatectomy where they use a robotic system and arms to operate the instrument with greater precision.

Often Recommended for:

  • Stage 1 or stage 2 prostate cancer

Possible Side Effects of LRP:

  • Erectile dysfunction or sexual impotence
  • Urinary incontinence
  • Changes in orgasm
  • Loss of fertility
  • Lymphedema (rare complication from removing too many lymph nodes, causing painful fluid buildup but usually treatable with physical therapy)
  • Changes in penis length (due to a shortening of the urethra)

Pros & Cons of LRP for Prostate Cancer

Pros:

  • Less blood loss and pain
  • Shorter hospital stays (usually just a day)
  • Catheter removed sooner (5–7 days)
  • More maneuverability, visibility and precision
  • Can be a curative option with a higher cure rate
  • Nerve-saving approach may help prevent impotence
  • Removed tissue helps accurately stage cancer

Cons:

  • Recovery of bladder control might take slightly more time
  • Requires more skills and doctor experience
  • Cancer in nearby lymph nodes most likely can’t be removed
  • Prostate gland may not be removed if cancer has spread
  • Surgical risks (reactions to anesthesia, bleeding or blood clots in legs or lungs, damage to nearby organs and Infections in the surgery site)
  • Unlikely to be performed after radiation
  • Longer recovery times and activity restrictions

Transurethral Resection of the Prostate (TURP) for Prostate Cancer

During this operation, your surgeon will remove part of the prostate to make it easier for your urine to exit through the bladder. There are no incisions with this surgery. A slender instrument called a resectoscope will be passed through the tip of your penis and into the urethra. Once in place, electricity or a laser is used to cut or vaporize the tissue.

Often Recommended for:

  • Advanced prostate cancer (stage 4)

Possible Side Effects of TURP:

  • Bleeding (up to a month)
  • Retrograde ejaculation (semen collects with urine and passes in the next urination)
  • Erectile dysfunction or sexual impotence
  • Urethral strictures (scarring causes further blockage)
  • Urinary incontinence
  • Infertility

Pros & Cons of TURP for Prostate Cancer

Pros:

  • Can fix or improve your urinary issues
  • Surgery does not involve incisions

Cons:

  • Risk of urinary symptoms worsening or not improving
  • Not a curative treatment for prostate cancer

Radiation Treatment Options for Prostate Cancer

Radiation along with hormone therapy may be used at several different stages of your treatment. It may be your first treatment option for low-grade cancers or for cancers that have grown outside of your prostate gland and into nearby tissues. It can also be a second treatment option if your cancer can’t be removed completely or returns to the prostate area after surgery. Lastly, if your cancer is advanced, radiation can also be used to help keep your cancer under control and help prevent or relieve symptoms. Due to advancements in the field, there are several radiation treatment options, including but not limited to: standard X-ray radiation, proton therapy and brachytherapy. Treatment times vary based on your cancer and treatment option, but sessions typically take place at an outpatient center and cause minimal treatment-related side effects.

Standard X-ray Radiation for Prostate Cancer

Standard X-ray radiation uses an external beam similar to an X-ray that contains no mass or electric charge. These beams are focused on your prostate gland and/or areas of the bone affected by advanced prostate cancer to emit highly penetrating rays that kill cancer cells by damaging their DNA. Before your treatment begins, your team of doctors will map out your radiation plan to find the right angles and radiation dose. You may also be fitted with a plastic mold, similar to a cast, to keep you in the optimal position during your treatment session.

Often Recommended for:

  • All cancer stages, including early and advanced
  • Bone pain relief
  • Those not healthy enough for surgery
  • Those for whom hormone therapy isn’t working

Possible Side Effects of Standard X-ray Radiation:

  • Rectal soreness
  • Erectile dysfunction and lowered testosterone levels
  • Urinary problems and incontinence
  • Rectal problems and gastrointestinal disorders due to radiation damage to rectum, bladder and bowel
  • Greater risk of diarrhea, nausea, headache and loss of appetite

Pros & Cons of Standard X-ray Radiation for Prostate Cancer

Pros:

  • Can be a curative option
  • No surgical risks or hospital stays
  • Non-invasive, typically painless procedure
  • Minimal treatment-related side effects

Cons:

  • Frequent treatment sessions (up to 5 days for 8–9 weeks)
  • Higher chance of developing long-term side effects
  • Recurrent or secondary cancer might not be able to be treated
  • Greater risk of damage to healthy tissues and surrounding organs
  • May not cure the cancer

Proton Therapy for Prostate Cancer

Proton therapy is a highly accurate and much less invasive form of radiation treatment. Protons are subatomic particles with a positive charge that can be manipulated and controlled to deliver the maximum dose directly at a tumor. Radiation stops precisely at the tumor wall to spare healthy tissues and surrounding organs. Proton therapy also uses intensity modulated radiation therapy (IMRT), a computer-driven machine that moves around you to shape the beam and adjust the dose at different angles. Similar to standard X-ray radiation, your team of doctors will map out a detailed radiation plan and possibly create a plastic mold to keep you in the optimal position during your treatment session.

Often Recommended for:

  • All cancer stages, including early and advanced
  • Recurrent or secondary cancer
  • Bone pain relief
  • Those not healthy enough for surgery
  • Those with concerns about impotence and incontinence
  • Those not responding to hormone therapy

Possible Side Effects of Proton Therapy:

  • Rectal soreness
  • Erectile dysfunction and lowered testosterone levels
  • Urinary problems and incontinence
  • Rectal problems and gastrointestinal disorders due to radiation damage to rectum, bladder and bowel
  • Diarrhea, nausea, headache and loss of appetite

Pros & Cons of Proton Therapy for Prostate Cancer

Pros:

  • Can be a curative option
  • No surgical risks or hospital stays
  • Non-invasive, typically painless procedure
  • Lower risk of treatment-related side effects, impotence and incontinence
  • Up to 97% chance of avoiding a recurrence
  • Up to 60% less radiation to surrounding organs
  • Shortened treatment time (30-60 minutes per session)
  • Hypofractionation treatment option (4–6 weeks vs. 8–9 weeks)
  • Lower chances of secondary cancers
  • May allow retreatment for those with secondary or recurrent cancer

Cons:

  • Requires frequent treatments (up to 5 days a week)
  • Higher chance of developing long-term side effects
  • May not cure the cancer

Brachytherapy (Internal Radiation Therapy) for Prostate Cancer

This is also known as implantation or interstitial radiation therapy because small radioactive seeds are placed directly in your prostate. Seldom do the seeds cause discomfort. Most doctors use Permanent Brachytherapy, but some opt for Temporary Brachytherapy. If Permanent Brachytherapy is recommended, your doctor will use a needle to insert around 100 seeds in your prostate. Seeds will release low doses of radiation for weeks or months until the radioactive material is completely dissolved. Temporary Brachytherapy delivers high doses of radiation through a catheter. Seeds are removable and kept in for only 5 to 15 minutes. Generally, there are 3 treatments given over the course of 2 days. The catheter is removed after your final treatment.

Often Recommended for:

  • Lower Gleason scores
  • Early-stage prostate cancer
  • Low-grade cancers
  • Those healthy enough for surgery
  • Those requiring combined treatment with external radiation

Possible Side Effects of Brachytherapy:

  • Pain or swelling in injection area between the anus and scrotum
  • Rectal pain, burning and/or diarrhea
  • Urinary and bowel issues
  • Erectile dysfunction

Pros & Cons of Brachytherapy for Prostate Cancer

Pros:

  • Can be a curative option
  • One-time, minimally invasive procedure
  • No surgical risks or hospital stays
  • Radiation concentrated in the prostate
  • Little damage to surrounding tissues, nerves, bladder and rectum

Cons:

  • Internal radiation may demand you to stay away from children and pregnant women, limit children and pets sitting on your lap for prolonged time periods, refrain airport travel and require a condom during sex
  • Seeds may require you strain urine
  • Might not work as well in men with large prostate glands, urinary problems or post-TURP surgery
  • May not cure the cancer

Hormone Therapy for Prostate Cancer

Otherwise known as androgen suppression therapy or androgen deprivation therapy (ADT), hormone therapy aims to shrink prostate cancers or slow their growth by targeting androgens (male hormones that stimulate prostate cells to grow). There are several treatment types and medications available to lower androgen levels, suppress them or stop them from working. Although hormone therapy may impede the growth of prostate cancer, it does not alone cure it. Nevertheless, it can be effective if used in conjunction with radiation therapy or surgery.

Often Recommended for:

  • Slowing growth and shrinking tumors
  • Prostate cancer that remains or recurs despite treatment
  • Those at higher risk of recurrent prostate cancer after treatment
  • Pre-radiation therapy for maximum effectiveness

Side Effects of Hormone Therapy:

  • Osteoporosis
  • Anemia
  • Higher cholesterol levels
  • Weight gain
  • Reduced mental awareness
  • Hot flashes
  • Erectile dysfunction or sexual impotence
  • Shrinkage of genitalia
  • Breast growth and tenderness
  • Reduced libido
  • Depression
  • Fatigue

Pros & Cons of Hormone Therapy for Prostate Cancer

Pros:

  • Helps shrink and inhibit prostate cancer cells
  • Potentially effective when used with other treatments

Cons:

  • Does not alone cure cancer
  • Risk of prostate cancer stagnation or recurrence
  • Most prostate cancers may become resistant to hormone therapy

Chemotherapy for Prostate Cancer

Chemotherapy, commonly known as chemo, is treatment that uses intravenous or oral anti-cancer drugs—like cabazitaxel, docetaxel, estramustine and mitoxantrone—to target cancers that have metastasized, or spread, outside the prostate. Once in the bloodstream, they move throughout the body, attacking any affected tissues or organs. Although not a standard treatment for prostate cancer, research has shown that chemo has the ability to slow its growth. That said, like hormone therapy, chemo is also unlikely to cure prostate cancer alone.

Often Recommended for:

  • Ineffective hormone therapy
  • Prostate cancer that has metastasized beyond the prostate

Possible Side Effects of Chemotherapy:

  • Diarrhea
  • Vomiting and nausea
  • Mouth sores
  • Possible bleeding/bruising
  • Higher odds of infections
  • Hair loss
  • Reduced appetite
  • Fatigue

Pros & Cons of Chemotherapy for Prostate Cancer

Pros:

  • Potentially effective for metastasized prostate cancer
  • Easily moves throughout the body via bloodstream
  • Can be taken intravenously or orally
  • Alternative to hormone therapy
  • May also be effective when given along with hormone therapy
  • May be helpful if given for a short time post-surgery

Cons:

  • Unlikely to cure cancer alone
  • Not recommended for early-stage prostate cancer
  • Rest periods are needed in between chemo cycles

Immunotherapy for Prostate Cancer

Immunotherapy is a minimally invasive treatment that uses the immune system to fight cancer cells. Immunotherapies such as Sipuleucel-T (Provenge®) stimulate immune cells to detect and attack tumors. Each dose is personalized with your own immune cells that have been removed and reengineered with an antigen to help grow and reactivate the T-cells. Treatment typically takes 6 weeks and is administered through the skin or IV in one infusion every 2 weeks. May be used alone or in conjunction with radiation and hormone therapy.

Often Recommended for:

  • Advanced prostate cancer
  • Recurrent cancer
  • Prostate cancer that is resistant to hormone therapy
  • Metastases exclusive to soft tissue or bone
  • Those with few or no symptoms of prostate cancer
  • Those who haven’t had chemotherapy in the past 3 months

Possible Side Effects of Immunotherapy:

  • Headache
  • Fatigue
  • Nausea
  • Joint pain

Pros & Cons of Immunotherapy for Prostate Cancer

Pros:

  • Potentially effective for metastasized prostate cancer
  • Relatively short treatment time (4–6 weeks)
  • May help make other treatments more effective
  • Fewer side effects than other treatments
  • Cancer may be less likely to return
  • Can slow cancer growth and alleviate symptoms to prolong life

Cons:

  • Unlikely to cure cancer alone
  • Relatively new and can be expensive
  • Many treatments are available only through clinical trials
  • May cause your immune system to attack other organs
  • Results are inconsistent and vary widely between men

Cryotherapy for Prostate Cancer

During this procedure, your doctor will use a transrectal ultrasound (TRUS) to guide multiple needles directly into your prostate. Very cold gases are sent through the needles to create “ice balls” that freeze and destroy the prostate. A warming catheter is then inserted in the urethra to protect it. You will use a catheter for around 3 weeks to help drain your bladder while you heal.

Often Recommended for:

  • Older men
  • Early-stage prostate cancer
  • Cancer not responding to standard treatments
  • Those for which radiation has failed or can’t tolerate surgery or radiation

Possible Side Effects of Cryotherapy:

  • Blood in urine
  • Pain or burning sensations in bladder and intestines
  • Damage to nerves near prostate
  • Erectile dysfunction
  • Bladder issues and loss of control
  • Bleeding or infection in treated area

Pros & Cons of Cryotherapy for Prostate Cancer

Pros:

  • Minimally invasive procedure
  • Less blood loss and pain
  • Shorter hospital stay and recovery
  • Concentrated treatment on cancer cells

Cons:

  • Relatively new, and long-term outcomes are unknown
  • Higher probability of erectile dysfunction
  • Not recommended for those with larger tumors, normal sexual function or who previously had surgery for rectal or anal cancer

New Treatment Options for Prostate Cancer

New technologies, scientific advancements and clinical trials continue to develop and test additional and alternative forms of classical treatments. Often, the only way to access these newer treatments and procedures is through a clinical trial. Participating in these carefully controlled research trials is another way to get state-of-the-art care that you might not be able to get otherwise. Still, certain factors may cause ineligibility or personal discomfort with a lesser known treatment plan.

Prostate Cancer Stages and Possible Treatment Options

Stage 1

Found exclusively in the prostate gland, prostate cancer is undetectable by DRE physical examinations or imaging tests. In the event of a slow growth rate, possibility of never experiencing symptoms or desire to delay treatment, active surveillance is a suggested option for younger men, older men or those who suffer from other serious health issues. For those who wish to start treatment, surgery, radiation and/or proton therapy with hormone therapy are frequently recommended for stage 1 prostate cancer to reduce the risk of spreading, especially for those men with higher Gleason scores and PSA levels. Alternative treatments like cryotherapy and brachytherapy may also be used. Prostate cancer is detected at this stage approximately 80% of the time, and the 5-year survival rate is almost 100%.

Stage 2

More advanced than in stage 1 but has yet to spread outside the prostate, prostate cancer cells at this stage have a higher Gleason score and are more likely to grow at a faster rate. Radiation therapy, proton therapy and/or surgery with hormone therapy are treatment options to further reduce the risk of the cancer spreading or returning. As with stage 1, active surveillance may still be beneficial for older men or those with other serious health issues. Like local stage prostate cancers, the 5-year survival rate for stage 2 prostate cancer is almost 100%.

Stage 3

At this stage, prostate cancer has spread beyond the prostate’s outer layer and could have potentially reached the seminal vesicles. The tumor has yet to spread to the rectum, bladder, distant organs or lymph nodes. Curative treatments include surgery and radiation or proton therapy with hormonal therapy. Radiation or proton therapy may be required post-surgery to provide additional local and distant cancer control. As with the previous stages, active surveillance is a suggested option for older men or those with other serious health issues. Similar to local stage prostate cancers, the 5-year survival rate is nearly 100%. Nonetheless, the chances of prostate cancer coming back after treatment are more likely with stage 3 prostate cancer.

Stage 4

The final stage, stage 4 prostate cancer, describes a tumor that has spread beyond the seminal vesicles to surrounding organs or tissues, such as the rectum, bladder, lymph nodes or bones. At this stage, advanced prostate cancer treatment of the whole body with systemic chemotherapy, immunotherapy or hormonal therapy is the mainstay. Radiation, proton therapy or TURP surgery may also be used for advanced or late-stage prostate cancer to control pain or shrink tumors. While treatment can only cure a small percentage of T4 tumors, these treatments may still be recommended to prolong or improve quality of life. The 5-year survival rate for these distance stage cancers is 29%.

Recurrent Cancer

In the event that your prostate cancer returns, your doctor may recommend different treatment options depending on your age, other serious health issues, metastasis (or lack thereof), cancer history and previous treatments. Recurrent cancer is classified as either a local recurrence or a distant or regional recurrence. A local recurrence is cancer that recurs in the prostate, while a distant recurrence is a group of cancer cells that has spread past the prostate to other organs, lymph nodes and/or bones. Because your body has gone through treatment before, your options may be limited as your tissues and organs may not be able to tolerate or have become resistant to certain treatments. More precise or concentrated treatments like proton therapy may be an option as they are proven to help spare healthy tissues and reduce damage to surrounding organs.

Life After Prostate Cancer Treatment

Once treatment is over, you’ll likely have frequent follow-up appointments with your doctor in the first couple of months to check your progress, track changes, detect any new issues and discuss additional treatment options if the cancer didn’t go away. For the first 5 years of remission, it’s common to see your doctor twice a year to continue to monitor and test the area. Lifestyle changes may be recommended to reduce the likelihood of your cancer returning.

Dealing with Impotence and Incontinence

Some treatments can result in a change of lifestyle when it comes to sex and urinating. Resuming normal sexual activities after prostate surgery and treatment can take time. After prostate removal, it takes most men 12 to 24 months to fully recover for sex. If you’re having trouble performing, there are several treatment options, including:

  • Phosphodiesterase-5 (PDE5) inhibitors, such as Viagra, Levitra and Cialis, can help with erections if the two nerves that control erections haven’t been damaged or removed.
  • Alprostadil injections five to 10 minutes before intercourse can help produce erections.
  • Vacuum device or mechanical pump is placed over your penis to increase blood flow to the penis and produce an erection.
  • Penile implants might restore your ability to have erections if other methods don’t work.

Urinary issues, especially after surgery, tend to be short-term for most men. Much like women after childbirth, the sphincter muscles that manage the release of urine may get temporarily damaged or need to be strengthened. Physical therapy and other exercises can help speed up the recovery process.