Choice of prostate cancer treatment is influenced by several factors. The treatment selected may be influenced by the patient’s age, concurrent health problems, life expectancy, characteristics of the individual’s cancer, the patient’s goals of treatment, and the bias of the treating physician. Treatment options include hormone therapy, surgery, radiation, combinations of therapy and “watchful waiting.” It is important to obtain as much information as possible about the results of each treatment and obtain more than one opinion, especially when deciding on surgery versus radiation therapy.
Several different doctors treat prostate cancer and may be involved with the diagnosis and management of prostate cancer including an urologist, radiation oncologist and a medical oncologist. Urologists are surgeons who specialize in treatment of disorders of the male genital tract, including prostate cancer. Urologists play an important role in the diagnosis and treatment of prostate cancer. Radiation oncologists use various forms of radiation to treat prostate cancer and medical oncologists are often involved when chemotherapy is required.
Surgery is used to diagnose, stage, and treat prostate cancer. Surgical removal of the prostate is considered a local treatment and is very effective treatment if the cancer has not spread beyond the prostate. Learn more about surgery.
In radiation therapy, high-energy X-rays are used to kill prostate cancer cells. 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 of prostate cancer, it may be given to relieve pain or other problems. Learn more about radiation therapy.
Testosterone is a male hormone produced mainly by the testicles. Many organs in the body are composed of cells that respond to or are regulated by exposure to testosterone. Cells in the prostate have testosterone receptors and when exposed to testosterone, are stimulated to grow. When cells that have testosterone receptors become cancerous, the growth of these cancer cells can be increased by exposure to testosterone. The basis of hormone therapy as a treatment for prostate cancer is to block or prevent the cancer cells from being exposed to testosterone. Learn more about hormone therapy.
Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment. Learn more about chemotherapy treatment of prostate cancer.
Targeted therapies are designed to treat only the cancer cells and minimize damage to normal, healthy cells. Treatments that “target” cancer cells may offer the advantage of reduced treatment-related side effects and improved outcomes.
Biological therapy is referred to by many terms, including immunologic therapy, immunotherapy, or biotherapy. Biological therapy is a type of treatment that uses the body’s immune system to facilitate the killing of cancer cells. Types of biological therapy include interferon, interleukin, monoclonal antibodies, colony stimulating factors (cytokines), and vaccines. Biologic therapies are being developed for the treatment of prostate cancer. Sipuleucel-T( Provenge®) is an immunotherapy that prompts the body’s immune system to respond against the cancer, and was recently approved by the FDA.
Some physicians and patients choose a strategy of delaying any treatment of prostate cancer until symptoms from the cancer appear. Because treatment with radiation or surgery may be associated with side effects, in addition to inconvenience, electing not to receive immediate treatment may be appropriate for selected patients especially those with other health concerns or a shorter life expectancy.
Watchful waiting is based on the premise that some patients will not benefit from definitive treatment of the primary prostate cancer. The decision is to forgo definitive treatment and to instead provide treatment to relieve symptoms of local or metastatic progression if and when it occurs. In contrast to watchful waiting, a program of active surveillance is based on the premise that some, but not all, patients may benefit from treatment of their primary prostate cancer. A program of active surveillance is designed to provide definitive treatment for men with localized cancers that are likely to progress and to reduce the risk of treatment-related complications for men with cancers that are not likely to progress. Clinical studies suggest that individuals with lower risk cancers could be candidates for this treatment strategy because they have a low risk for clinical progression of their cancer within the first 10 to 15 years after the diagnosis. Thus, this treatment strategy may be best suited for men with a shorter life expectancy.