What are the treatment options for prostate cancer?

A variety of treatments are available for prostate cancer. The choice of which option is best for you will depend upon the location and size of the tumor, whether the cancer has spread, side effects of treatment, and your personal preferences.

Radical prostatectomy involves removal of the entire prostate gland and some surrounding tissue. This procedure can be performed as an open surgery, laparoscopically (through a small incision in the skin and with use of a flexible lighted tube with a video camera attached and thin instruments), and laparoscopically with the aid of a robot (the surgical instruments are attached to a machine and controlled by a surgeon using a console). Side effects include bladder problems and sexual side effects.

External beam radiation therapy involves the use of computer imaging to map out the precise location of the cancer cells in order to target a high level of radiation only to that area. The treatment is painless and is given in a short dose (1 minute) five days a week for about eight weeks. Side effects include diarrhea, problems urinating, fatigue, and possibly sexual side effects.

Radioactive seeds implants are about the size of a grain of rice and are implanted directly into the tumor. They give off a small amount of radiation over a few months to kill cancer cells. Side effects include problems urinating, diarrhea, and other rectal problems.

Cyotherapy or cryosurgery involves inserting a small metal tool into the tumor and destroying the cancer cells by freezing them. Side effects include sexual and urinary side effects.

Chemotherapy uses chemicals to destroy cancer cells. Because of the side effects associated with chemotherapy (nausea, fatigue, killing of healthy cells, etc), this therapy is usually reserved for men whose disease has spread to other parts of the body.

Watchful waiting means that no treatment is given, but your doctor will monitor you carefully to see if the tumor grows. This may be an option for men whose tumor is small and expected to grow slowly and in older men who may live their normal lifespan without having their cancer spread or cause other problems. Hormone therapy is designed to stop your body from making testosterone, which can stimulate the growth of cancer cells. This can be used to shrink a tumor before using other therapies or can be used alone. Side effects can include sexual problems, hot flashes, weight gain, and bone thinning.

The best methods of treatment for prostate cancer include:

If the cancer is early and localized, surgery to remove the prostate (radical prostatectomy) or radiation therapy are the two most common treatments. With radical prostatectomy, the prostate is removed from above the pubic bone or between the scrotum and rectum. Possible side effects include incontinence, with leakage of urine, and impotence with erectile dysfunction. The latter occurs less often with surgery techniques that protect the nerves that supply the penis.
 
Radiation therapy is the other major treatment for early prostate cancer. This type of treatment takes 6 to 7 weeks by external beam radiation therapy, which is directed at the prostate to destroy cancer cells. Also possible is radiation therapy using radioactive implants. The risks include intestinal problems with rectal bleeding, diarrhea, and abdominal pain and other problems. From 25 to 80 percent of men develop impotence with erectile dysfunction after radiation therapy. Erection problems may develop months after the treatment is completed. Difficulty urinating, painful or frequent urination happen in some patients, yet this side effect is usually not permanent.

For more advanced prostate cancer, other treatments are available and have been found to be effective. Your urologist can guide you. Treatments available include hormone treatment with estrogens that stop the production of testosterone and therefore remove its effect on the prostate cancer cells.

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The standard treatment options of prostate cancer are:

1. Active surveillance
2. Radical prostatectomy (open or robotic) 
3. Radiation (either brachytherapy seeds or external beam)   
4. Cryotherapy