Treatment
Active Surveillance
Surgery
Radiation Therapy
Hormone Therapy
Chemotherapy
Men with prostate cancer have many treatment
options. The treatment that's best for one man may
not be best for another. The options include
active surveillance (also called watchful waiting), surgery,
radiation therapy, hormone therapy, and chemotherapy.
You may have a combination of treatments.
The treatment that's right for you depends mainly on
your age, the grade of the tumor (the Gleason score),
the number of biopsy tissue samples that contain
cancer cells, the stage of the cancer, your symptoms,
and your general health. Your doctor can describe your
treatment choices, the expected results of each, and the
possible side effects. You and your doctor can work
together to develop a treatment plan that meets your
medical and personal needs.
You may want to talk to your doctor about taking
part in a clinical trial, a research study of new
treatment methods. See the section on Taking Part in
Cancer Research.
Your doctor may refer you to a specialist, or you
may ask for a referral. You may want to see a urologist,
a surgeon who specializes in treating problems in the
urinary or male sex organs. Other specialists who treat
prostate cancer include urologic oncologists, medical oncologists, and
radiation oncologists. Your health care
team may also include an oncology nurse and a
registered dietitian.
Before treatment starts, ask your health care team
about possible side effects and how treatment may
change your normal activities. For example, you may
want to discuss with your doctor the possible effects on
sexual activity. The NCI booklet Treatment Choices for
Men with Early-Stage Prostate Cancer can tell you
more about treatments and their side effects.
At any stage of the disease, supportive care is
available to relieve the side effects of treatment, to
control pain and other symptoms, and to help you cope
with the feelings that a diagnosis of cancer can bring.
You can get information about coping on the NCI Web
site at http://www.cancer.gov/cancertopics/coping and from NCI's Cancer
Information Service at 1-800-4-CANCER or
LiveHelp
(http://www.cancer.gov/help).
You may want to ask your doctor these
questions before choosing your treatment:
- What is the grade of the tumor?
- What is the stage of the disease? Has the
cancer spread? Do any lymph nodes show
signs of cancer?
- What is the goal of treatment? What are my
treatment choices? Which do you recommend
for me? Why?
- What are the expected benefits of each type of
treatment?
- What are the risks and possible side effects of
each treatment? How can side effects be
managed?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for
how long?
- How will treatment affect my normal
activities? Will it affect my sex life? Will I
have urinary problems? Will I have bowel
problems?
- What will the treatment cost? Will my
insurance cover it?
- Would a clinical trial (research study) be
appropriate for me?
- Can you recommend other doctors who could
give me a second opinion about my treatment
options?
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You may choose active surveillance if the risks and
possible side effects of treatment outweigh the possible
benefits. Your doctor may suggest active surveillance if
you're diagnosed with early stage prostate cancer that
seems to be slowly growing. Your doctor may also
offer this option if you are older or have other serious
health problems.
Choosing active surveillance doesn't mean you're
giving up. It means you're putting off the side effects
of surgery or radiation therapy. Having surgery or
radiation therapy is no guarantee that a man will live
longer than a man who chooses to put off treatment.
If you and your doctor agree that active surveillance
is a good idea, your doctor will check you regularly
(such as every 3 to 6 months, at first). After about one
year, your doctor may order another biopsy to check
the Gleason score. You may begin treatment if your
Gleason score rises, your PSA level starts to rise, or
you develop symptoms. You'll receive surgery,
radiation therapy, or another approach.
Active surveillance avoids or delays the side effects
of surgery and radiation therapy, but this choice has
risks. For some men, it may reduce the chance to
control cancer before it spreads. Also, it may be harder
to cope with surgery or radiation therapy when you're
older.
If you choose active surveillance but grow
concerned later, you should discuss your feelings with
your doctor. Another approach is an option for most
men.
You may want to ask your doctor these
questions before choosing active surveillance:
- If I choose active surveillance, can I change
my mind later on?
- Is it safe for me to put off treatment?
- How often will I have checkups? Which tests
will I need? Will I need a repeat biopsy?
- How will we know if the prostate cancer is
getting worse?
- Between checkups, what problems should I tell
you about?
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Surgery is an option for men with early (Stage I or
II) prostate cancer. It's sometimes an option for men
with Stage III or IV prostate cancer. The surgeon may
remove the whole prostate or only part of it.
Before the surgeon removes the prostate, the lymph
nodes in the pelvis may be removed. If prostate cancer
cells are found in the lymph nodes, the disease may
have spread to other parts of the body. If cancer has
spread to the lymph nodes, the surgeon does not
always remove the prostate and may suggest other
types of treatment.
There are several types of surgery for prostate
cancer. Each type has benefits and risks. You and your
doctor can talk about the types of surgery and which
may be right for you:
- Open surgery: The surgeon makes a large incision
(cut) into your body to remove the tumor. There are
two approaches:
- Laparoscopic prostatectomy: The surgeon removes
the entire prostate through small cuts, rather than a
single long cut in the abdomen. A thin, lighted tube
(a laparoscope) helps the surgeon remove the
prostate.
- Robotic laparoscopic surgery: The surgeon
removes the entire prostate through small cuts. A
laparoscope and a robot are used to help remove the
prostate. The surgeon uses handles below a
computer display to control the robot's arms.
- Cryosurgery: For some men, cryosurgery is an
option. The surgeon inserts a tool through a small
cut between the scrotum and anus. The tool freezes
and kills prostate tissue. Cryosurgery is under study.
See the section on Taking Part in Cancer Research.
- TURP: A man with advanced prostate cancer may
choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a
long, thin scope through the urethra. A cutting tool
at the end of the scope removes tissue from the
inside of the prostate. TURP may not remove all of
the cancer, but it can remove tissue that blocks the
flow of urine.
You may be uncomfortable for the first few days or
weeks after surgery. However, medicine can help
control the pain. Before surgery, you should discuss the
plan for pain relief with your doctor or nurse. After
surgery, your doctor can adjust the plan if you need
more pain relief.
The time it takes to heal after surgery is different for
each man and depends on the type of surgery. You may
be in the hospital for one to three days.
After surgery, the urethra needs time to heal. You'll
have a catheter. A catheter is a tube put through the
urethra into the bladder to drain urine. You'll have the
catheter for 5 days to 3 weeks. Your nurse or doctor
will show you how to care for it.
After surgery, some men may lose control of the
flow of urine (urinary incontinence). Most men regain
at least some bladder control after a few weeks.
Surgery can damage the nerves around the prostate.
Damaging these nerves can make a man impotent
(unable to have an erection). In some cases, your
surgeon can protect the nerves that control erection.
But if you have a large tumor or a tumor that's very
close to the nerves, surgery may cause impotence.
Impotence can be permanent. You can talk with your
doctor about medicine and other ways to help manage
the sexual side effects of cancer treatment.
If your prostate is removed, you will no longer
produce semen. You'll have dry orgasms. If you wish
to father children, you may consider sperm banking or
a sperm retrieval procedure before surgery.
You may want to ask your doctor these
questions before choosing surgery:
- What kinds of surgery can I consider? Which
operation do you recommend for me? Why?
- How long will I be in the hospital after
surgery?
- How will I feel after the operation?
- If I have pain, how can we control it?
- Will I have any lasting side effects? What is
the chance that the surgery will cause
incontinence or impotence?
- Is there someone that I can talk with who has
had the same surgery that I'll be having?
- How often will I need checkups?
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Radiation therapy is an option for men with any
stage of prostate cancer. Men with early stage prostate
cancer may choose radiation therapy instead of surgery.
It also may be used after surgery to destroy any cancer
cells that remain in the area. In later stages of prostate
cancer, radiation treatment may be used to help relieve
pain.
Radiation therapy (also called radiotherapy) uses
high-energy rays to kill cancer cells. It affects cells only
in the treated area.
Doctors use two types of radiation therapy to treat
prostate cancer. Some men receive both types:
- External radiation: The radiation comes from a
large machine outside the body. You will go to a
hospital or clinic for treatment. Treatments are
usually 5 days a week for several weeks. Many men
receive 3-dimensional conformal radiation therapy
or intensity-modulated radiation therapy. These
types of treatment use computers to more closely
target the cancer to lessen the damage to healthy
tissue near the prostate.
- Internal radiation (implant radiation or
brachytherapy): The radiation comes from
radioactive material usually contained in very small
implants called seeds. Dozens of seeds are placed
inside needles, and the needles are inserted into the
prostate. The needles are removed, leaving the seeds
behind. The seeds give off radiation for months.
They don't need to be removed once the radiation is
gone.
Side effects depend mainly on the dose and type of
radiation. You're likely to be very tired during radiation
therapy, especially in the later weeks of treatment.
Resting is important, but doctors usually advise
patients to try to stay active, unless it leads to pain or
other problems.
If you have external radiation, you may have
diarrhea or frequent and uncomfortable urination.
Some men have lasting bowel or urinary problems.
Your skin in the treated area may become red, dry, and
tender. You may lose hair in the treated area. The hair
may not grow back.
Internal radiation therapy may cause incontinence.
This side effect usually goes away.
Both internal and external radiation can cause
impotence. You can talk with your doctor about ways
to help cope with this side effect.
You may find it helpful to read the NCI booklet
Radiation Therapy and You.
You may want to ask your doctor these
questions before choosing radiation therapy:
- Which type of radiation therapy can I
consider? Are both types an option for me?
- When will treatment start? When will it end?
How often will I have treatments?
- Will I need to stay in the hospital?
- What can I do to take care of myself before,
during, and after treatment?
- How will I feel during treatment? Will I be
able to drive myself to and from treatment?
- How will we know the treatment is working?
- How will I feel after the radiation therapy?
- Are there any lasting effects?
- What is the chance that the cancer will come
back in my prostate?
- How often will I need checkups?
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A man with prostate cancer may have hormone
therapy before, during, or after radiation therapy.
Hormone therapy is also used alone for prostate cancer
that has returned after treatment.
Male hormones (androgens) can cause prostate
cancer to grow. Hormone therapy keeps prostate cancer
cells from getting the male hormones they need to
grow. The testicles are the body's main source of the
male hormone testosterone. The adrenal gland makes
other male hormones and a small amount of
testosterone.
Hormone therapy uses drugs or surgery:
- Drugs: Your doctor may suggest a drug that can
block natural hormones:
- Surgery: Surgery to remove the testicles is called
orchiectomy.
After orchiectomy or treatment with an LH-RH
agonist, your body no longer gets testosterone from the
testicles, the major source of male hormones. Because
the adrenal gland makes small amounts of male
hormones, you may receive an antiandrogen to block
the action of the male hormones that remain. This
combination of treatments is known as total androgen blockade (also called combined androgen blockade).
However, studies have shown that total androgen
blockade is no more effective than surgery or an
LH-RH agonist alone.
Hormone therapy causes side effects such as
impotence, hot flashes, and loss of sexual desire. Also,
any treatment that lowers hormone levels can weaken
your bones. Your doctor can suggest medicines that
may reduce your risk of bone fractures.
An LH-RH agonist may make your symptoms
worse for a short time at first. This temporary problem
is called "flare." To prevent flare, your doctor may give
you an antiandrogen for a few weeks along with the
LH-RH agonist.
An LH-RH agonist such as leuprolide can increase
body fat, especially around the waist. The levels of
sugar and cholesterol in your blood may increase too.
Because these changes increase the risk of diabetes and
heart disease, your health care team will monitor you
for these side effects.
Antiandrogens (such as nilutamide) can cause
nausea, diarrhea, or breast growth or tenderness.
Rarely, they may cause liver problems (pain in the
abdomen, yellow eyes, or dark urine). Some men who
use nilutamide may have shortness of breath or
develop heart failure. Some may have trouble adjusting
to sudden changes in light.
If you receive total androgen blockade, you may
have more side effects than if you have just one type of
hormone treatment.
If used for a long time, ketoconazole may cause
liver problems, and aminoglutethimide can cause skin
rashes.
Doctors usually treat prostate cancer that has spread
to other parts of the body with hormone therapy. For
some men, the cancer will be controlled for two or
three years, but others will have a much shorter
response to hormone therapy. In time, most prostate
cancers can grow with very little or no male hormones,
and hormone therapy alone is no longer helpful. At that
time, your doctor may suggest chemotherapy or other
forms of treatment that are under study. In many cases,
the doctor may suggest continuing with hormone
therapy because it may still be effective against some
of the cancer cells.
You may want to ask your doctor these
questions before choosing hormone therapy:
- Which kind of hormone therapy can I
consider? Would you recommend drugs or
surgery? Why?
- If I have drugs, when will treatment start? How
often will I have treatments? When will
treatment end?
- If I have surgery, how long will I need to stay
in the hospital?
- How will I feel during treatment?
- What can I do to take care of myself during
treatment?
- How will we know the treatment is working?
- Which side effects should I tell you about?
- Will there be lasting side effects?
- How often will I need checkups?
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Chemotherapy may be used for prostate cancer that
has spread and no longer responds to hormone therapy.
Chemotherapy uses drugs to kill cancer cells. The
drugs for prostate cancer are usually given through a
vein (intravenous). You may receive chemotherapy in a
clinic, at the doctor's office, or at home. Some men
need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are
given and how much. Chemotherapy kills fast-growing
cancer cells, but the drugs can also harm normal cells
that divide rapidly:
- Blood cells: When chemotherapy lowers the levels
of healthy blood cells, you're more likely to get
infections, bruise or bleed easily, and feel very weak
and tired. Your health care team will check for low
levels of blood cells. If your levels are low, your
health care team may stop the chemotherapy for a
while or reduce the dose of drug. There are also
medicines that can help your body make new blood
cells.
- Cells in hair roots: Chemotherapy may cause hair
loss. If you lose your hair, it will grow back, but it
may change in color and texture.
- Cells that line the digestive tract: Chemotherapy
can cause a poor appetite, nausea and vomiting, or
diarrhea. Your health care team can give you
medicines and suggest other ways to help with these
problems.
Other side effects include shortness of breath and a
problem with your body holding extra water. Your
health care team can give you medicine to protect
against too much water building up in the body. Also,
chemotherapy may cause a skin rash, tingling or
numbness in your hands and feet, and watery eyes.
Your health care team can suggest ways to control
many of these problems. Most go away when treatment
ends.
You may wish to read the NCI booklet
Chemotherapy and You.
You may want to ask your doctor these
questions before choosing chemotherapy:
- Why do I need this treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- What are the expected benefits of the
treatment?
- What are the risks and possible side effects of
treatment? What can we do about them?
- When will treatment start? When will it end?
- How will treatment affect my normal
activities?
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