treatments for prostate cancer

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Source: National Cancer Institute

Prostate cancer treatment options can be confusing and the decision about which treatment is right for you can be difficult to make.

Getting a Second Opinion About Prostate Cancer Treatment

Decisions about prostate cancer treatment involve many factors. Before making a decision, a man may want to get a second opinion by asking another doctor to review the diagnosis and treatment options. A short delay will not reduce the chance that treatment will be successful.

Some health insurance companies require a second opinion; many others will cover a second opinion if the patient requests it. There are a number of ways to find a doctor who can give a second opinion:

The patient's doctor may be able to recommend a specialist or team of specialists to consult. Doctors who treat prostate cancer are urologists, radiation oncologists, and medical oncologists. Patients may find it helpful to talk to a specialist in each of these areas. Different types of specialists may have different thoughts about how best to manage prostate cancer.
The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
People can get the names of doctors from their local medical society, a nearby hospital, or a medical school.
The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their speciality and their educational background. This resource, produced by the American Board of Medical Specialities (ABMS), is available in most public libraries. The ABMS also has an online service that lists many board-certified physicians (http://www.certifieddoctor.org).

Preparing for Prostate Cancer Treatment

The doctor develops a treatment plan to fit each man's needs. Treatment for prostate cancer depends on the stage of the disease and the grade of the tumor (which indicates how abnormal the cells look, and how likely they are to grow or spread). Other important factors in planning treatment are the man's age and general health and his feelings about the treatments and their possible side effects.

Many men with prostate cancer want to learn all they can about their disease, their treatment choices, and the possible side effects of treatment, so they can take an active part in decisions about their medical care. Prostate cancer can be managed in a number of ways (with watchful waiting, surgery, radiation therapy, and hormonal therapy). If the doctor recommends watchful waiting, the man's health will be monitored closely, and he will be treated only if symptoms occur or worsen. Patients considering surgery, radiation therapy, or hormonal therapy may want to consult doctors who specialize in these types of treatment.

The patient and his doctor may want to consider both the benefits and possible side effects of each option, especially the effects on sexual activity and urination, and other concerns about quality of life. Also, the patient may want to talk with his doctor about taking part in a research study to help determine the best approach or to study new kinds of treatment.

These are some questions a patient may want to ask the doctor before treatment begins:

What is the stage of the disease?
What is the grade of the disease?
What are my treatment choices? Is watchful waiting a good choice for me?
Are new treatments under study? Would a clinical trial be appropriate for me?
What are the expected benefits of each kind of treatment?
What are the risks and possible side effects of each treatment? How can the side effects be managed?
Is treatment likely to affect my sex life?
Am I likely to have urinary problems?
Am I likely to have bowel problems, such as diarrhea or rectal bleeding?
Will I need to change my normal activities? If so, for how long?

Methods of Prostate Cancer Treatment

Treatment for prostate cancer may involve watchful waiting (sometimes called active surveillance), surgery, radiation therapy, or hormonal therapy. Some patients receive a combination of therapies. In addition, doctors are studying other methods of treatment to find out whether they are effective against this disease.

Active Surveillance as a Treatment for Prostate Cancer

Watchful waiting/active surveillance may be suggested for some men who have prostate cancer that is found at an early stage and appears to be slow growing. Also, watchful waiting may be advised for older men or men with other serious medical problems. For these men, the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits. Men with early stage prostate cancer are taking part in a study to determine when or whether treatment may be necessary and effective.

Surgery as a Treatment for Prostate Cancer

Surgery is a common treatment for early stage prostate cancer. The doctor may remove all of the prostate (a type of surgery called radical prostatectomy) or only part of it. In some cases, the doctor can use a new technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

The doctor can describe the types of surgery and can discuss and compare their benefits and risks.

In radical retropubic prostatectomy, the doctor removes the entire prostate and nearby lymph nodes through an incision in the abdomen.
In radical perineal prostatectomy, the doctor removes the entire prostate through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.
In laparoscopic prostatectomy, the surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube, a laparoscope helps the surgeon remove the prostate.
In robotic laparoscopic surgery, the surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot's arms.
For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue.
In transurethral resection of the prostate (TURP), the doctor removes part of the prostate with an instrument that is inserted through the urethra. The cancer is cut from the prostate by electricity passing through a small wire loop on the end of the instrument. This method is used mainly to remove tissue that blocks urine flow.

If the pathologist finds cancer cells in the lymph nodes, it is likely that the disease has spread to other parts of the body. Sometimes, the doctor removes the lymph nodes before doing a prostatectomy. If the prostate cancer has not spread to the lymph nodes, the doctor then removes the prostate. But if cancer has spread to the nodes, the doctor usually does not remove the prostate, but may suggest other treatment.

These are some questions a patient may want to ask the doctor before having surgery:

What kind of operation will I have?
How will I feel after the operation?
If I have pain, how will you help?
How long will I be in the hospital?
When can I get back to my normal activities?
Will I have any lasting side effects?
What is my chance of a full recovery?

Radiation as a Treatment for Prostate Cancer

Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill cancer cells. Like surgery, radiation therapy is local therapy; it can affect cancer cells only in the treated area. In early stage prostate cancer, radiation can be used instead of surgery, or it may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages, it may be given to relieve pain or other problems.

Radiation may be directed at the body by a machine (external radiation), or it may come from tiny radioactive seeds placed inside or near the tumor (internal or implant radiation, or brachytherapy). Men who receive radioactive seeds alone usually have small tumors. Some men with prostate cancer receive both kinds of radiation therapy.

For external radiation therapy, patients go to the hospital or clinic, usually 5 days a week for several weeks. Patients may stay in the hospital for a short time for implant radiation.

You may want to ask your doctor these questions before choosing radiation therapy:

Which type of radiation therapy can I consider? Are both types an option for me?
When will treatment start? When will it end? How often will I have treatments?
Will I need to stay in the hospital?
What can I do to take care of myself before, during, and after treatment?
How will I feel during treatment? Will I be able to drive myself to and from treatment?
How will we know the treatment is working?
How will I feel after the radiation therapy?
Are there any lasting effects?
What is the chance that the cancer will come back in my prostate?
How often will I need checkups?

Hormonal Therapy as a Treatment for Prostate Cancer

Hormonal therapy keeps cancer cells from getting the male hormones they need to grow. It is called systemic therapy because it can affect cancer cells throughout the body. Systemic therapy is used to treat cancer that has spread. Sometimes this type of therapy is used to try to prevent the cancer from coming back after surgery or radiation treatment.

There are several forms of hormonal therapy:

Orchiectomy is surgery to remove the testicles, which are the main source of male hormones.
Drugs known as luteinizing hormone-releasing hormone (LH-RH) agonists can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin.
Drugs known as antiandrogens can block the action of androgens. Two examples are flutamide and bicalutamide.
Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.

After orchiectomy or treatment with an LH-RH agonist, the body no longer gets testosterone from the testicles. However, the adrenal glands still produce small amounts of male hormones. Sometimes, the patient is also given an antiandrogen, which blocks the effect of any remaining male hormones. This combination of treatments is known as total androgen blockade. Doctors do not know for sure whether total androgen blockade is more effective than orchiectomy or LH-RH agonist alone.

You may want to ask your doctor these questions before choosing hormone therapy:

Which kind of hormone therapy can I consider? Would you recommend drugs or surgery? Why?
If I have drugs, when will treatment start? How often will I have treatments? When will treatment end?
If I have surgery, how long will I need to stay in the hospital?
How will I feel during treatment?
What can I do to take care of myself during treatment?
How will we know the treatment is working?
Which side effects should I tell you about?
Will there be lasting side effects?
How often will I need checkups?

Prostate cancer that has spread to other parts of the body usually can be controlled with hormonal therapy for a period of time, often several years. Eventually, however, most prostate cancers are able to grow with very little or no male hormones. When this happens, hormonal therapy is no longer effective, and the doctor may suggest other forms of treatment that are under study.

Chemotherapy as a Treatment for Prostate Cancer

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.

Chemotherapy uses drugs to kill cancer cells. The drugs for prostate cancer are usually given through a vein. You may receive chemotherapy in a clinic, at the doctor's office, or at home. Some men need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

Blood cells: When chemotherapy lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of drug. There are also medicines that can help your body make new blood cells.
Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may change in color and texture.
Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, or diarrhea. Your health care team can give you medicines and suggest other ways to help with these problems.

Other side effects include shortness of breath and a problem with your body holding extra water. Your health care team can give you medicine to protect against too much water building up in the body. Also, chemotherapy may cause a skin rash, tingling or numbness in your hands and feet, and watery eyes. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

You may want to ask your doctor these questions before choosing chemotherapy:

Why do I need this treatment?
Which drug or drugs will I have?
How do the drugs work?
What are the expected benefits of the treatment?
What are the risks and possible side effects of treatment? What can we do about them?
When will treatment start? When will it end?
How will treatment affect my normal activities?

Source
http://cancer.gov
NCI's Web site contains comprehensive information about cancer causes and prevention, screening and diagnosis, treatment and survivorship; clinical trials; statistics; funding, training, and employment opportunities; and the Institute and its programs.
See the complete index of What You Need To Know About™ Cancer publications.

Posted January 2004
Updated October 2009