What are the treatment options for prostate cancer?

For most men diagnosed with prostate cancer, the common treatment options are:

• Active surveillance

• Surgery (a prostatectomy)

• Radiation therapy

Additional prostate cancer treatment options may include cryotherapy, hormone therapy, chemotherapy, and immunotherapy.

Active surveillance for prostate cancer involves regular checkups and monitoring of low-grade prostate cancers that have Gleason scores of 6 or less. Active surveillance may be discussed alongside other treatment options for prostate cancer and may be used to help determine if or when additional intervention may be needed. Active surveillance may be an option if you:

• Are risk averse: Active surveillance is used to avoid treatment side effects when the risk of the prostate cancer progressing is very low

• Are older or have other serious health problems: In such cases, an invasive procedure such as surgery may not be a treatment option, especially with slow-growing cancer

Active surveillance is not for everybody. It is important to talk to your doctor to see if it’s the right fit.

A prostatectomy, or the surgical removal of the prostate, is a common treatment plan for low-grade prostate cancer that has not spread beyond the prostate.

There are three major types of surgery for prostate cancer:

In this type of prostatectomy, the surgeon makes an incision in the abdomen and removes the prostate gland directly. This is the more common option because the surgeon can remove nearby lymph nodes as well if there’s concern the cancer could spread.

After surgery, you may need to stay in the hospital for a few days and limit your activity for a few weeks during recovery.

Radical perineal prostatectomy involves the surgeon making an incision between the scrotum and anus and removing the prostate gland. This operation is used less often because the potential for erectile dysfunction is higher and lymph nodes cannot be removed in this manner.

For this type of procedure, a hospital stay of a few days followed by limited activity for several weeks during recovery is standard.

A more advanced prostatectomy involves manually guiding telescopic surgical instruments and a camera through ports in the stomach to the surgical site. The surgeon can perform the prostatectomy without major incisions, compared to the other methods.

It’s important to note that any of these surgeries, like other treatment options, may lead to side effects, including erectile dysfunction and urinary dysfunction. Your doctor is your best source for information on the risks and benefits of the above treatment options. Talk to your doctor for a complete listing of risks, warnings, and important safety information.

Other problems that may occur during or after a prostatectomy include, but are not limited to:

• Reaction to anesthesia

• Bleeding

• Blood clots

• Nearby organs damaged

• Surgery site infections

Radiation therapy is typically used to treat stage 1 and stage 2 prostate cancer. It may complement other treatment options (like hormone therapy or surgery) if the cancer has spread beyond the prostate and is stage 3 or above.

There are two main types of radiation therapy.

When undergoing external beam radiation, high-energy beams of radiation are focused on the prostate gland from a machine outside the body. Some potential benefits of external beam radiation may be: 

• It’s non-invasive and the procedure itself is painless 
• The treatment lasts only a few minutes and is an outpatient procedure 
• Newer techniques and technologies allow higher doses of radiation to target the cancer, while limiting exposure to healthy tissues nearby 

There are two types of brachytherapy: low-dose rate (LDR) and high-dose rate (HDR). The type of brachytherapy you may receive depends on your specific situation.

With LDR brachytherapy, small seeds of radioactive pellets are placed into your prostate. Sometimes, the radioactive pellets are left in position permanently.

With HDR brachytherapy, multiple catheters attached to a single radioactive source are placed temporarily into the tumor for a few minutes and then removed. Tumors can be treated with very precise doses of localized radiation, which reduces the risk to surrounding healthy tissues.

The advantage of brachytherapy is that it has relatively high precision because the pellets can be placed in a very targeted manner.

Your doctor is your best source for information on the risks and benefits of the above treatment options. Talk to your doctor for a complete listing of risks, warnings, and important safety information.

Potential side effects of the above radiation therapies include, but are not limited to:

• Bowel problems
• Urinary problems
• Erection problems, including impotence
• Feeling tired
• Lymphedema

Although radiation therapy may be an effective treatment option for prostate cancer, the potential side effects may affect a patient’s quality of life.

Due to its proximity to the prostate, the rectum may be exposed to radiation that is targeting the prostate during external beam and brachytherapy radiation treatments. This exposure may lead to several side effects, some of which are listed above.

There are, however, techniques and products that may help to mitigate the side effects of prostate cancer treatments like radiation therapy. 

SpaceOAR™ Hydrogel is an absorbable polyethylene glycol (PEG)-based hydrogel that is intended to create a temporary space between the rectum and prostate. It is designed to reduce the radiation dose delivered to the rectum during prostate cancer radiation therapy. The SpaceOAR Hydrogel is made primarily of water and PEG, and SpaceOAR Vue also contains iodine to assist with CT scan visibility. SpaceOAR Hydrogel is placed by a doctor and stays in place for about three months during radiation treatment. It is naturally absorbed by the body at about six months after placement; however, it may take longer to fully absorb. 

SpaceOAR Hydrogel has clinically proven results when used with radiation therapy. In studies of 222 patients, 149 of whom received SpaceOAR Hydrogel, patients treated with SpaceOAR Hydrogel reported the following outcomes at a median of 3 years follow-up after treatment: 

• Evidence of fewer bowel complications: SpaceOAR Hydrogel patients experienced 75% less Grade 1 rectal toxicity (e.g., urgency, loose stools, and frequency) compared to the control group (spacer group: 2%, control group: 9%, p<.03).¹ 
• Evidence of urinary quality of life: The use of SpaceOAR Hydrogel reduced the likelihood of either a minimally important difference (which may mean a noticeable or worsening of symptoms) or a more serious change in urinary quality of life compared to the control group (spacer group: 17%, control group: 8%).¹ 
• Evidence of preserved sexual function: Approximately 67% of SpaceOAR Hydrogel patients who were potent at baseline (meaning they were able to achieve erections sufficient for sex before treatment) had erections sufficient for sex after the procedure compared to the control group (spacer group: 66.7%, control group: 37.5% P = .046).²

As with any medical treatment, there are risks associated with the use of SpaceOAR Hydrogel. Be sure to talk to your doctor so you thoroughly understand the risks and benefits associated with the application.

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