Once we discover a patient has prostate cancer and determine which of the prostate cancer stages it is in, we work with him to determine the appropriate treatment. This can range from merely monitoring the cancer to surgically removing the whole prostate.
How we help the patient select the particular treatment for his prostate cancer involves several considerations. Together, the doctor and patient must consider the prostate cancer stage, his overall health, age and life expectancy, personal preferences and more.
Balancing these factors to arrive at a treatment plan can be difficult and requires open communication. The physicians at Urology Associates help their patients with this decision, which can be very different based on the individual and their condition.
The American Cancer Society suggests that the patient should consider the following in deciding on treatment.
- Is he willing to risk side effects that may come from treatment?
- Is he okay with only monitoring the situation, which can lead to anxiety and eventual treatment anyway?
- Some treatments may cause a specific side effect such as erection issues, incontinence or bowel problems, so what side effects is he most concerned about?
- Is the amount of time spent in surgery or in treatments a concern?
- Does he want to pursue traditional treatments or consider newer technologies such as CyberKnife or robotic surgery?
Patients can find support programs and other services that can help with these decisions offered through the American Cancer Society.
Prostate cancer stages
Most of the time doctors find prostate cancer at an early stage when it is most effectively cured and when just about all treatment options can be appropriate. Cancer specialists categorize prostate cancer stages from the smallest and least active tumors to the largest and fastest spreading.
First a pathologist gives the cancer biopsy a score (usually on the Gleason scoring system) based on how likely the tumor is to spread. In addition to this and other means of evaluating the cancer, the Tumor, Nodes and Metastasis system helps doctors classify the cancer into 1 of 4 stages. This staging greatly affects treatment choices.
The cancer is small, confined to the prostate and grows slowly. These cancers may not ever cause a problem or present symptoms. Stage I treatment options are watchful waiting, radiation and surgery. (See more about considering these and other options below.)
Cancer is larger and still confined to the prostate, but if left untreated is more likely than a stage I cancer to spread and cause symptoms. Treatment options are the same as for a stage I. Younger, healthy men with stage II may want to pursue surgery and forms of radiation therapy that might be accompanied by hormone therapy. Clinical trials may also be a good option for them.
Cancer has spread beyond the prostate but not to the bladder, rectum, lymph nodes or organs farther away. Stage III cancer is more apt to recur following treatment. These include radiation, surgery, hormone therapy and clinical trials.
The prostate cancer has spread to such nearby areas as the bladder, rectum and lymph nodes and possibly to distant organs and the bones. Most stage IV cancers can’t be cured, and treatment often focuses on containing the cancer and increasing the man’s quality of life, including pain reduction. Stage IV treatments include radical prostatectomy surgery, radiation, hormone therapy and chemotherapy.
The treatments outlined by stages above are initial treatment options. If the cancer has returned after a treatment, the doctor may use different combinations of treatments.
Evaluating prostate cancer treatment options
Following are pros and cons of the prostate cancer treatment options.
Monitoring the cancer
Monitoring the cancer without pursuing other treatments can be done in two ways. Watchful waiting is a noninvasive, follow-up approach for slow-growing cancers that generally monitors symptom changes. Active surveillance is for cancers that are growing faster and involves more frequent tests and possible biopsies. These are good choices in many cases where the man isn’t experiencing symptoms, is older and may have health problems that indicate the prostate cancer will not be what kills him.
- It involves no treatments and those accompanying risks
- There’s no chance of a side effect from treatment
- Takes less time and effort
- The cancer can grow faster than expected, and a chance may have been missed to cure it with treatment
- Some patients stress out and have anxiety from not knowing more about their cancer that treatment could reveal
- Active surveillance involves more office visits and tests
Radiation therapy uses x-rays, electron beams, gamma rays or protons to damage or destroy the cancer cells. Radiation will make small breaks in the DNA inside cells causing them to die.
- Usually a first treatment for early stage cancers that haven’t spread, with a cure rate about the same as radical prostatectomy
- Beneficial as part of treatment for cancers that have spread beyond the prostate
- Good for recurring prostate cancer
- Helps slow the growth and relieve symptoms in fast-growing prostate cancer
- Most often with radiation therapy, doctors won’t know if it has gotten rid of the cancer for a while, and this presents a problem for some men
- Side effects include problems with erections, bowels and continence, fatigue and swelling and pain in the legs caused by damaged lymph nodes
- Internal radiation may require patient precautions, such as staying away from pregnant women and children, straining urine for radiation seeds that may have moved, and wearing a condom during sex
Chemotherapy, commonly shortened to chemo, is any drug used to treat cancer. Chemo works throughout the whole body and can kill cancers that have spread to locations of the body other than the primary tumor.
- Chemo is a systematic treatment beneficial in fighting quickly-growing cancer cells that have spread throughout the body
- Newer drugs being used may help men live longer and reduce symptoms better than older forms of chemo drugs
- May be beneficial following surgery for early stage cancers
- Chemotherapy is not likely to cure prostate cancer
- Side effects, varying by drug, dosage and individual, include hair loss, poor appetite, mouth sores, infection, easy bleeding and bruising, fatigue, nausea and diarrhea
- Treatments are given in cycles and may require a number of office visits that take time
Hormone therapy, also known as androgen suppression therapy or androgen deprivation therapy, aims to reduce levels of male hormones (androgens) to stop them from growing prostate cancer cells.
- Hormone therapy can often work when the cancer has spread beyond the potential for radiation or surgery to stop it
- It can be used when a patient isn’t able to have surgery or radiation for some reason
- Beneficial to add to radiation and surgery treatments on cancers that return
- The application of hormone therapy and its benefits is debated by many doctor. Disagreements include whether it should be used on early-stage cancers, which hormone and other drug combinations to use, how it should be administered, and when to start or stop it.
- Some studies, though not enough to be conclusive, suggest it increases risk of high blood pressure, heart attack, stroke and diabetes
- It can have many side effects, such as erectile dysfunction, low sex drive, anemia, hot flashes, reduced mental sharpness, weight gain, depression, memory loss, fatigue and more. Some of these can be prevented or effectively treated
The surgery for prostate cancer is removal of the prostate and often tissue and lymph nodes in the area. This is called a radical prostatectomy.
- Can cure stage I and II prostate cancers and sometimes stage III cancers
- Does not require frequent office visits
- Results are most often known rather quickly
- Some men who have surgery rather than less invasive approaches may worry that their prostate cancer would not have ever been enough of a problem to require the inconvenience and risks of surgery
- All forms of radical prostatectomy carry risks including bleeding, infections, blood clotting, damaged organs and reaction to anesthesia
- Very rarely, people die because of surgical complications
- Men lose their fertility because the surgery cuts the vas deferens which allows sperm to leave the body
- Side effects can include several forms of urinary incontinence, erectile dysfunction, no ejaculate during sexual climax, swelling in the legs or genitals
- Increases the chance of a groin hernia in the future