How We Treat Prostate Cancer

Not every man with prostate cancer needs to be treated right away. In many cases, early-stage prostate cancer will not spread or cause any side effects for quite a while, if ever. Because of this, your doctor may recommend not treating your prostate cancer immediately with invasive treatments, but instead suggest actively monitoring your cancer. This treatment plan is known as watchful waiting. Treatment can be done if the cancer grows quickly or causes any concerning symptoms.

When the decision is made to treat prostate cancer, surgery is the most common choice if the cancer has not spread outside the prostate gland. Your surgical procedure depends on the specific type of cancer, where it is, how much it has spread and other factors. Surgery often involves a radical prostatectomy, where the entire prostate gland, seminal vesicles and some healthy tissue are removed. Your doctor may also do surgery to see if the cancer has spread to your lymph nodes or your bones, which may require other types of treatment after surgery.

Radiation therapy uses high-energy X-rays to kill cancer cells. It may be the first line of treatment for cancer that has not spread or be used in combination with hormone therapy for cancers that have spread slightly into the surrounding soft tissue. It may be used after surgery to kill cancer cells that remain in the prostate or any cancer that returns. Radiation may also be chosen to keep cancer under control if it is advanced and to help prevent and relieve symptoms. There are two types of radiation therapy for prostate cancer, which may be used individually or at the same time:

• External-beam radiation therapy (EBRT) - Uses a machine similar to an X-ray machine to deliver radiation to your prostate
• Internal radiation or brachytherapy - Uses tiny radioactive seeds or tubes put into your body to send radiation to your prostate

Also known as cryosurgery or cryoablation, cryotherapy is used to treat early-stage prostate cancer. Cryotherapy uses very cold temperatures to freeze and kill prostate cancer cells. It’s not recommended as the first line of treatment, but is used if the cancer has returned following radiation therapy.

This treatment stops the growth of cancer cells that rely on certain hormones. Hormone therapy is done through medicines, such as LHRH analogs, CYP17 inhibitors or anti-androgens, or through removal of the testicles, which make hormones. Hormone therapy may be used after surgery or radiation therapy to decrease the chance of prostate cancer coming back or of a new cancer growing. It’s used to treat cancer that has spread when other treatment options aren’t available. It’s sometimes used as an initial treatment with radiation therapy if you’re at a high risk of the cancer returning after treatment. This is determined by your Gleason score high PSA levels and / or growth of the cancer outside the prostate. 

Vaccine treatment

Sipuleucel-T is a cancer vaccine that boosts the immune system to help it attack prostate cancer cells. The vaccine is used to treat advanced prostate cancer that is no longer responding to hormone therapy. The vaccine is custom made for each individual using their white blood cells and given through an IV three times over the course of six weeks.

Chemotherapy and infusion use powerful medicines to kill cancer cells all through the body. They may be used to shrink a tumor before surgery or to kill any cancer cells that remain after local treatments. Chemotherapy may also treat cancer that has appeared in other places in the body. Prostate cancer that has spread can be treated with chemotherapy, usually in combination with hormone therapy if hormone therapy alone isn’t working well enough.

Current studies are underway to determine if chemotherapy is a beneficial treatment if given for a short time after prostate surgery.