Treatments for Prostate Cancer
by Beth G. Hodges, MD

Treatments for prostate cancer depend on the aggressiveness of the tumor, the staging of the disease, and the overall health of the patient. The proper treatment regimen for a particular patient must be decided by the patient, the urologist, and sometimes also a radiation oncologist and a medical oncologist all working together. Below is a summary of the various treatment options, many of which can be used in combination.

Active surveillance

Active surveillance, often called watchful waiting, means no treatment is done, at least initially. This approach can be used in very slow growing cancers, very early cancers, and men with other serious medical conditions that would make tolerating treatment for prostate cancer difficult or even dangerous. The patient is monitored for signs of progression, mostly through PSA and digital rectal exam every six months.

Surgery

Surgical therapies are several, but the traditional one is a radical prostatectomy, in which the entire prostate gland is removed. A nerve-sparing prostatectomy, somewhat more palatable for a man trying to preserve sexual function, cuts out the majority of the prostate but is careful to leave a thin rim to avoid cutting the erectile nerves. Robotic prostatectomy is the newest surgical procedure, and is actually done by a "robotic surgical arm" under the guidance of a urologic surgeon.

Radiation Therapy

There are three types of radiation therapy. The first is external beam radiation. The second is proton therapy, a newer and more precise (but more expensive) option. The third is Brach therapy, also called radiation seed implants. As it sounds, radioactive pellets, called seeds, are implanted in the cancerous tissue and give off radiation to the involved tissue for up to a year, at which time the seeds become inert.

Hormonal Therapy

Hormone therapy blocks testosterone release. It is testosterone that feeds the cancer, so blocking it suppresses cancer growth, though is not considered curative by itself. Blocking testosterone can be done by surgically removing the testicles or by regular injections of a hormone agonist.

Chemotherapy

Recently, chemotherapy, not previously used commonly for prostate cancer, has been gaining some ground in the treatment arena and is in certain cases to be considered.

Treatments for prostate cancer must take into account the health of the patient, his goals, the stage and aggressiveness of the disease, and sometimes cost in order for the best overall decisions to be made.

Published - October, 2009