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Treatment Options

Reviewing the Most Common Treatment Options

Receiving a prostate cancer diagnosis can be overwhelming and frightening. For many, the first questions are usually “Will I survive this?” and “What’s the next step?” Luckily, prostate cancer is extremely treatable if caught early enough, but deciding which treatment option to go with remains critical. It’s important to talk about not only which option has the best possibility of treating the root of the disease, but also which will allow for optimal quality of life in the years following.

Newly diagnosed prostate cancer patients are encouraged to consult with multiple doctors to assess available treatment options and outcomes. Physicians in different specialties, such as radiation oncologists and urologists, can provide different information and give unique opinions to aid in the creation of a treatment plan. This is called shared decision-making. During the decision-making process, it’s important to keep in mind the level of risk and grade of cancer, as well as your personal preferences relating to the risks and benefits of the therapies available to you.

For someone diagnosed with locally advanced prostate cancer, there are three common options: active surveillance, surgery and radiation. At this stage, decisions are based on a combination of clinical factors, including the stage and grade of cancer, age, overall health, and the risks and benefits associated with each treatment option.

Active Surveillance

Prostate cancer is a slow-growing disease, and in some cases, it is unlikely to harm or decrease life expectancy. Active surveillance is an option for men who decide not to go through with treatment and have confined, low risk prostate cancer (grade 1, Gleason 6, PSA<10). During active surveillance, prostate cancer is carefully monitored for signs of progression. This observation takes place through yearly PSA blood tests, digital rectal exams and prostate biopsies.

Active surveillance is a viable option for men who are older and find more risk in other available treatment options. Extreme changes or rising PSA levels may warrant looking into other treatment options.

Radiation

External beam radiation therapy involves the killing of cancer cells with ionizing radiation or photons, damaging the cell DNA and preventing it from growing and spreading. Internal radiation therapy uses a radioactive substance that is placed directly near or into the cancer through wires, seeds, needles or catheters. MRIs and CT scans are used to map out the growth and location of the tumors, and radiation is then targeted to these areas. Radiation is done on an outpatient basis and is noninvasive, with treatment sessions usually taking place five days a week over a six-to-nine week period.

Radiation treatment does have side effects, including rectal pain and bleeding and urinary problems, particularly right after finishing treatment. The severity depends on the type of radiation used and the dose size, as well as the length and area of treatment. In recent years, many effective techniques to target the radiation to the tumor have been implemented. Intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) are constantly improving to pinpoint exactly where the radiation is being directed to help avoid damaging any surrounding tissue. Hydrogel spacers can be placed in between the prostate and the rectum to prevent damage to the surrounding organs and allow doctors to more accurately target and kill the cancer. Radiation effectively treats prostate cancer and is increasingly being used in conjunction with these technologies to minimize any harmful side effects that could impact quality of life.

Surgery

The surgical treatment for localized prostate cancer is called a radical prostatectomy, which is when a surgeon removes the entire prostate gland and some surrounding tissue. Doctors aim to remove all of the cancer cells, while limiting the amount of damage to surrounding organs. The surgery can be done open, laparoscopically or robotically, and is a common option for men whose cancer is still in the early stages and confined to the prostate. Robotic radical prostatectomy is the most common approach, due to smaller incisions and shorter recovery time.

It’s important to remember outcomes may vary depending on the skill level and experience of the surgeon- as important nerves and organs surround the prostate which could become damaged or injured. Common side effects from surgery include incontinence and impotence. Surgical techniques, such as nerve-sparing prostatectomies, offer the best chance in preserving long-term erectile function- but surgeons are unable to tell if the erectile nerves can be spared until time of procedure.