Treatment Options for Prostate Cancer
Once prostate cancer is diagnosed, the next step is a treatment plan.
The prostate cancer treatment is established according to several factors
such as: the cancer stage and grade, the patient's age and expected life
span, and the general health state.
There are two main types of cancer treatment: local therapy
(type of treatment that either removes or destroys the cancer cells) and
systemic therapy (treatment that involves medication
that is administrated in various ways such as orally, or intravenously).
Surgery: This is a local type of therapy and is recommended in
early stages of cancer that can remove the whole prostate, prostatectomy,
or part of the prostate transurethral resection of the prostate
There are three types of prostatectomies:
- Radical retropubic prostatectomy is a common medical
procedure where the entire prostate and adjacent affected lymph nodes
are removed through an abdominal incision. For retropubic prostatectomy,
the incision is located between the navel and pubic bone. This surgery
can be performed under general anesthesia or local anesthesia (spinal
or epidural anesthesia). The advantage of retropubic prostatectomy is
that it provides a better chance of sparing the urethra by preserving
urinary continence and the neurovascular bundles (responsible for erections).
- Radical perineal prostatectomy is a rare medical procedure
where the prostate is removed through a small incision cut between the
scrotum and the anus. This type of prostatectomy is less invasive and
the patient recovers faster. It is performed in the early stages of
cancer when the lymph nodes are not affected and for very obese patients.
- Laparoscopic prostatectomy: During this procedure the
prostate and affected lymph nodes are removed through a small abdominal
incision. This procedure uses a special medical instrument called a
laparoscope (a thin lighted tube) to remove the prostate. The advantages
of this type of surgery are: greater precision and control, less blood
loss and pain, faster recovery, and less hospitalization.
of the prostate (TURP) is a type of surgery that is a palliative
treatment approach (relieves the symptoms, but does not cure).
This surgery is usually performed for those patients that have
urinary problems (the urine flow is blocked by the size of the
tumor). Transurethral resection of the prostate uses a resectoscope
to remove the tumor from the prostate. A resectoscope is a long,
thin medical instrument that sends out electricity which heats
and vaporizes the tumor tissue. The main disadvantage of this
procedure is the possibility of not removing the entire cancerous
tissue. This surgery is performed under general or local anesthesia
(epidural anesthesia). After surgery, a catheter is inserted through
the penis into the bladder to help the urine to drain while the
Prostate cancer can be also treated with a new type of surgery
called cryosurgery (or cryotherapy). This
type of procedure treats cancer by freezing it. During the surgery, a thin
needle is inserted into the perineum area (between anus and scrotum) into
the prostate. This needle sends out cold gases that creates ice balls
and destroys the cancerous prostate tissues. Because the urethra is in
danger to freeze and become nonfunctional during this procedure, a catheter
with warm saltwater is inserted into the urethra. Cryosurgery is less
invasive than a radical prostatectomy and involves less blood loss, less
pain, shorter hospitalization, and faster recovery.
Surgery, as a prostate cancer treatment option, has several risks and
possible side effects:
- General side effects of surgery: anesthesia risks
(heart attack, stroke, blood clots), infections of the incision, bleeding
during and after the surgery (if the blood vessels around the prostate
- Specific side effects: urinary incontinence (incapacity
to control urine), impotence (incapacity to have an erection).
Radiotherapy is another local type of cancer treatment that uses high-energy
rays or particles to destroy cancerous cells. It is used as a treatment
option for early stages of cancer, and for advanced stages of cancer (usually
in combination with hormone therapy).
There are four types of radiotherapy used for prostate cancer treatment:
- External Beam Radiation Therapy: This form of radiation therapy
uses an external device called a linear accelerator that generates an
external beam. This procedure is similar with an x-ray and each treatment
section is short (few minutes). Before being exposed to this type of
radiotherapy, the patient will undergo an imaging scan, (like an MRI
scan, CT scan or x-ray) to determine the exact tumor location. Throughout
the radiation session, the patient lays down on a bed while the radiation
device moves around the bed delivering radiation beams from different
- Intensity Modulated Radiation Therapy: This is an advanced
form of external beam radiation that focuses the radiation beam to the
affected area of the prostate while sparing the healthy tissues. This
type of treatment requires up to 40 radiation exposures every day for
eight weeks. Before each session, the patient will undergo ultrasounds
to ensure that the prostate has not shifted between treatments sessions.
- Internal Radiation Therapy or Brachytherapy: This is a form
of radiotherapy that uses small radioactive pellets implanted into the
prostate. This treatment option is used for patients with early stages
of cancer that have a slow growth rate.
- Proton Therapy:This is a form of radiation therapy that uses
positively charged particles that directs the beam through a prescribed
depth to treat the prostate tumor. This treatment option decreases the
radiation side effects on surrounding healthy areas and increases the
dose of radiation delivered straight to the prostate.
The main side effects of radiation therapy are: impotence, urination
problems (frequent urination, burning on urination, stronger urge to urinate),
bowel problems, and rectum soreness.
Chemotherapy is not a common treatment option for prostate cancer. However,
it is used for advanced forms or recurrent cancer that did not respond
to other types of treatment.
Hormone therapy is also known as androgen deprivation or suppression therapy
and focuses on reducing the level of male hormones in the body. The majority
of prostate cancer cases are hormone sensitive because tumors require
male hormones to grow. A reduced level of androgens (male hormone) causes
the prostate to shrink and have a slower growth process. This type of
treatment is effective in treating early cancer stages and high grade
tumors. Also, hormone therapy is available as a treatment option:
- for patients that cannot undergo a surgery or radiation therapy,
- for patients that did not respond to surgery or radiation therapy
and the cancer spread beyond the prostate,
- the cancer relapses,
- in addition to radiation therapy for a better outcome,
- before surgery or radiation therapy to shrink the tumor and to make
them more effective
There are three types of hormone therapy available for prostate cancer
Orchiectomy: This is a surgical procedure where
the testicles are removed. The testicles are two small organs that
produce almost 90 percent of the androgens, mostly testosterone. Without
the testicles, and with a decreased amount of androgen, the prostate
shrinks. This is a simple, effective procedure that efficiently reduces
the male hormones produced by the body, but is also a permanent measure
that can be very difficul for men to adjust to and accept. The main
side effect of this intervention is a reduced or absent libido and
impotence. Other side effects are: hot flashes, a tender sensation
in the breasts and even breast tissue growth, osteoporosis, anemia,
mental sharpness decrease, loss of muscle mass, fatigue, weight gain,
Luteinizing hormone-releasing hormone (LHRH) analogs
therapy: LHRH analogs are a family of drugs that reduce the level
of testosterone by decreasing the amount of androgen produced by the
testicles. LHRH drugs overstimulate the pituitary gland to produce
luteinizing hormone-releasing hormones causing the testicles to suppress
testosterone production. These drugs are administrated through injections
or as small implants under the skin at different periods of time (monthly,
or every 3, 4, or 6 month intervals, or once an year.) After the first
administration, the level of testosterone increases briefly in order
to decrease later. This type of therapy has similar side effects as
the orchiectomy, but the treatment is not permanent and can be stopped
when the patient cannot cope anymore with its side effects. This type
of treatment has less sexual side-effects then an orchiectomy.
Anti-androgen treatment: Anti-androgens block
the body's ability to use the androgens and prevent the cancerous
cells to interact with testosterone. This type of treatment is often
used in combination with the orchiectomy or LHRH analogs therapy,
or when these two treatment option do not work. There are several
side effects of anti-androgen treatment like diarrhea, nausea, liver
problems, and fatigue.
Update: In late March, 2007, the FDA approved Provenge as vaccine
like treatment in late stage prostate cancer patients. The drug slows
the progression rate of the disease by one to two weeks and allows patients
to live an average of 3.3 to 4.5 months longer. More Information on Provenge
Article by Alina Morrow, MS
Page Covers: What is the treatment for prostate cancer? How is treated?