Treatment:

The best treatment for your prostate cancer may not always be clear. Sometimes, your doctor may recommend one treatment because of what is known about your type of cancer and your risk factors. Other times, your doctor will talk with you about two or more treatments that could be good for your cancer.

In the early stages, talk to your doctor about several options, including surgery and radiation therapy. In older patients, simply monitoring the cancer with PSA tests and biopsies may be an option.

Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.

Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance. Problems with urine control are common after surgery and radiation therapy. These problems may either improve over time or get worse, depending on the treatment. Discuss your concerns with your health care provider.

SURGERY

Surgery is usually only recommended after a thorough evaluation and discussion of the benefits and risks of the procedure.

• Surgery to remove the prostate and some of the tissue around it is an option when the cancer has not spread beyond the prostate gland. This surgery is called radical prostatectomy. It can also be done with robotic surgery.
• Possible problems after the surgeries include difficulty controlling urine or bowel movements and erection problems.

RADIATION THERAPY

Radiation therapy uses high-powered x-rays or radioactive seeds to kill cancer cells.

Radiation therapy works best to treat prostate cancer that has not spread outside of the prostate. It may also be used after surgery, if there is a risk that prostate cancer cells may still be present. Radiation is sometimes used for pain relief when cancer has spread to the bone.

External beam radiation therapy uses high-powered x-rays pointed at the prostate gland.

• It is done in a radiation oncology center usually connected to a hospital. You will come to the center from home 5 days a week for the treatments. The therapy lasts for 6 -8 weeks.
• Before treatment, a therapist will mark the part of the body that is to be treated with a special pen.
• The radiation is delivered to the prostate gland using a device that looks like a normal x-ray machine. The treatment itself is generally painless.
• Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions, rectal burning or injury, diarrhea, bladder urgency, and blood in urine.

Prostate brachytherapy involves placing radioactive seeds inside the prostate gland.

• A surgeon inserts small needles through the skin behind your scrotum to inject the seeds. The seeds are so small that you don't feel them. They can be temporary or permanent.
• Brachytherapy is often used for men with smaller prostate cancer that is found early and is slow-growing.
• It also may be given with external beam radiation therapy for some patients with more advanced cancer.
• Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea.

Proton therapy is another kind of radiation used to treat prostate cancer. Doctors aim proton beams onto a tumor, so there is less damage to the surrounding tissue.

HORMONE THERAPY

Testosterone is the body's main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is any treatment that decreases the effect of testosterone on prostate cancer. These treatments can prevent further growth and spread of cancer.

Hormone therapy is mainly used in men whose cancer has spread to help relieve symptoms. There are two types of drugs used for hormone therapy.

The primary type is called a luteinizing hormone-releasing hormones (LH-RH) agonist:

• These medicines block the body from making testosterone. The drugs must be given by injection, usually every 3 - 6 months.
• They include leuprolide, goserelin, nafarelin, triptorelin, histrelin, buserelin, and degarelix.
• Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, decreased muscle mass, weight gain, and impotence.

The other medications used are called androgen-blocking drugs.

• They are often given along with the above drugs.
• They include flutamide, bicalutamide, and nilutamide.
• Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.

Much of the body's testosterone is made by the testes. As a result, removal of the testes (called orchiectomy) can also be used as a hormonal treatment. This surgery is not done very often.

Chemotherapy and immunotherapy are used to treat prostate cancers that no longer respond to hormone treatment. An oncology specialist will usually recommend a single drug or a combination of drugs.

MONITORING

After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups, including serial PSA blood tests (usually every 3 months to 1 year).

Support Groups:

You can ease the stress of illness by joining a support group whose members share common experiences and problems. See: Support group - prostate cancer

Expectations (prognosis):

The outcome varies greatly. It is mostly affected by whether the cancer has spread outside the prostate gland and how abnormal the cancer cells are (the Gleason score) when you are diagnosed.

Many patients with prostate cancer that has not spread can be cured, as well as some patients whose cancer has not spread very much outside the prostate gland.

Even for patients who cannot be cured, hormone treatment can extend their life by many years.

Complications:

The complications of prostate cancer are mostly due to different treatments.

Calling your health care provider:

Discuss the advantages and disadvantages to PSA screening with your health care provider.