Considering Your Prostate Cancer Treatment Options
Treating prostate cancer used to mean either undergoing a radical prostatectomy, or active surveillance, depending on how aggressive the cancer. Today, researchers are discovering advances in the way we diagnose and treat prostate cancer.
Talking to your doctor about your options is the best way to choose the right treatment; however, due to the sheer number of options available to you, the process can be confusing.
Below, we break down a few of the most common treatment options, how they work, and what you can expect if you choose to undergo them.
How it works: In most men, prostate cancer grows so slowly that a course of immediate treatment is not recommended or necessary. Instead, your doctor may recommend that you regularly undergo biopsies, prostate-specific antigen tests, and digital rectal exams to monitor the growth of the cancer. This process is called active surveillance.
This treatment may be right for you if: your prostate cancer is slow and nonaggressive.
Side Effects: There are no physical side effects to active surveillance; however, some men report feeling anxious about the progression of their cancer.
Additionally, biopsies used to monitor the tumor may present side effects, such as infection.
How it works: A radical prostatectomy prevents prostate cancer from spreading to other areas of the body through surgery to remove the prostate and its surrounding tissue. Occasionally, to ensure the cancer has not metastasized, a surgeon may decide to remove the lymph nodes around the prostate.
Radical prostatectomies are performed in two ways: open – performed either retropubicly (via an incision made from pubic bone to the lower stomach), or perineally (via a small incision in the perineum) – and laparoscopically, in which a small laparoscope with a camera attached is inserted through a small incision in the stomach.
This treatment may be right for you if: your cancer is at risk of spreading, or if the tumor has grown large enough to cause discomfort.
Side effects: The surgeon may have to remove the nerves attached to the penis in order to remove all of the cancer. These nerves affect a man’s ability to have an erection, and their removal may cause erectile dysfunction. Incontinence, urethral or rectal damage, blood clots or loss, and infections are all potential side effects of the surgery.
The process of cryoablation, often called “focal therapy,” is used to freeze the prostate gland.
How it works: A cryoablation patient will be put under either general or localized anesthesia. A catheter will then be inserted into the patient’s urethra – along with temperature monitors on the rectal wall – to lower the risk of urinary incontinence.
A cryoprobe, designed to assess the size of the prostate, is then inserted into the rectum. This helps surgeons regulate the shape and size of the ice, which will be used to freeze the prostate tissue.
Following the cryoprobe, long needles are placed in the prostate gland, guided by ultrasound imaging. These needles produce argon gas, which turns into the ice balls that will freeze the tissue.
This treatment may be right for you if: your prostate cancer has returned after your initial treatment.This procedure is referred to as salvage treatment, and is rarely considered a first course of treatment.
Side effects: Side effects of cryoablation include: urinary incontinence (due to post-surgical nerve swelling), erectile disfunction, and, in some cases, blood in the urine.
Additionally, some cancerous tissue may be left behind by the procedure, requiring you to follow up regularly with your doctor to monitor its growth.
How it works: Radiation kills cancer cells and the tissue surrounding these cells, through direct exposure to radiation. Typically, there are three types of radiation: external beam radiation, in which cancer cells and the material that causes their growth are targeted by x-rays; brachytherapy, which uses radioactive pellets to target cancer cells; and proton therapy, which directly attacks cancerous tissue through the protons of energy particles.
This treatment may be right for you if: you have been diagnosed with low grade, slow growing cancer. Radiation may also be used in conjunction with hormone therapy or to shrink the prostate in men whose cancer has advanced.
Side effects may include: impotence and other erectile issues, bowel dysfunctions, urinary incontinence, and fatigue are all side effects of radiation. Because radiation is extremely harmful, couples who are trying to conceive should avoid this type of treatment.
How it works: Chemotherapy drugs, such as Taxotere, Docetaxel, or Docefrez, treat cancer by targeting the microtubules responsible for cell division. Most cells divide slowly, but cancerous cells divide rapidly and are, therefore, killed quickly by the chemotherapy drugs.
Chemotherapy is administered either orally, or through injections, over the course of a one-to-three-week period, depending on the type of cancer. Chemotherapy treatments usually last for an hour.
This treatment may be right for you if: your cancer continues to progress and does not respond to hormone therapies, such as androgen deprivation therapy.
Side effects include: adverse reactions with certain foods, hair loss, nausea, low red blood cell counts, an increase in liver enzymes, fluid retention, and vomiting.
How it works: Hormone therapies, such as androgen deprivation therapy, work by reducing the androgen hormones, such as testosterone, that are believed to cause the prostate cancer to grow. ADT can be administered through drugs, such as Zytiga, or in the form of degarelix injections (such as Firmagon).
Occasionally, ADT is conduction through surgical castration, or the removal of the testicles, which produce androgen hormones.
This treatment may be right for you if: the cancer has spread beyond the prostate gland, and surgery or radiation are not possible. Hormone therapy is typically the first course of treatment with many prostate cancers, and is used to shrink the prostate before radiation, or alongside chemotherapy drugs.
Side effects: In some cases, low testosterone can cause decreased muscle mass, exhaustion, depression and erectile dysfunction. Reduced libido, weight gain and anemia are also associated with hormone therapy.
Choosing The Right Treatment
It is important to consider and research all of your treatment options, expressing any questions or concerns to your doctor, before choosing one.
Remember that each of the above treatments will impact every person differently. The best course of treatment for you will depend on your personal health history, your doctor’s recommendation, and the stage and grade of your cancer.