How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
Quality Of Life Issues
Overall, the available evidence is in favour of a moderate survival advantage with surgery compared to radiotherapy. However, surgery may have significant morbidity, especially in terms of erectile dysfunction and incontinence. With the increasingly young age of patients undergoing radical prostate surgery, this potentially has a great impact on quality of life issues. Comparative studies on QoL issues suggest that surgery has a higher rate of urinary incontinence compared to radiotherapy, 8% versus 1%, respectively. Both treatment modalities do result in impaired sexual function, but overall sexual function is similar between the two groups.7 However, reported erectile dysfunction is more prevalent in the surgery group at 79.3% versus 63.5% at 5 years. Conversely, radiotherapy does result in more bowel-related problems mainly tenesmus, urgency and rectal bleeding.
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How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer
A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.
Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.
If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.
To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.
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What Active Surveillance Means
For many men, prostate cancer never affects their lives, said Christopher L. Runz, DO, attending urologist at University of Maryland Shore Regional Health. Active surveillance means we actively watch the cancer and make sure it stays low-grade, which means the cancer may potentially never spread.
Active surveillance requires regular prostate specific antigen screenings and MRIs, with occasional biopsies. Men who are older and have a shorter life expectancy become candidates for active surveillance when they have a Gleason score of 7 .
Treatments To Help Manage Symptoms
Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:
This is the team of health professionals involved in your care. It is likely to include:
- a specialist nurse
- a therapeutic radiographer
- other health professionals, such as a dietitian or physiotherapist.
Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.
Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.
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Radiation Therapy For Prostate Cancer
We offer state of the art radiation therapy options including intensity modulated radiation therapy and stereotactic body radiotherapy. Intensity-Modulated radiation therapy is an advanced technology available at Mount Carmel which shapes the radiation beams to the prostate and minimizes radiation to nearby organs. The CyberKnife is used to deliver stereotactic body radiation therapy at Mount Carmel St. Anns Hospital. The CyberKnife uses a robotic arm to track and treat the prostate with greater precision. This also results in less radiation to nearby organs and reduces the treatment time to just 5 visits. CyberKnife is available in Central Ohio only at Mount Carmel St. Anns and is not offered at any other nearby facility.
Prostate Cancer Caregiver Podcast Series
We are proud to announce a new podcast series geared toward helping give support, hope and guidance to prostate cancer caregivers. The goal of this Prostate Cancer Caregiver Podcast Series is to help others connect with a diverse group of people who have felt the impact of prostate cancer in their lives and empower them on their journey.
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Who Will Be On My Treatment Team
From the time that you are diagnosed with prostate cancer, you may be cared for by one or more of a team of health professionals, including:
- your family/whnau doctor who will often be the first person you see
- a urologist a doctor who specialises in the care of men with prostate cancer, providing medical and surgical care
- medical oncologists doctors who are responsible for prescribing targeted therapies, immunotherapy, chemotherapy and other aspects of cancer care
- radiation oncologists doctors who specialise in the use of radiation treatment
- radiation therapists people who plan and give you your radiationtreatment
- a cancer nurse coordinator and/or clinical nurse specialist a person who acts as a point of contact for you in different parts of the health service. They support and guide you and your family/whnau to keep you fully informed about your care
- outpatient nurses nurses who work alongside doctors during their clinics.
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
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Surgery To Remove The Testicles
Your testicles make most of your testosterone. Surgery to remove the testicles is a type of hormone therapy because it quickly cuts your testosterone levels.
This operation used to be common, but most men with prostate cancer don’t get it any more. Instead, they take medicines that lower hormone levels while leaving the testicles in place.
If you do get the surgery, it’s an “outpatient” procedure, which means you won’t have to stay in the hospital. Your doctor may also give you anti-androgen therapy.
Can Prostate Cancer Be Completely Cured
Prostate cancer is the second most common cancer in men. The average age of diagnosis is 66 year olds, although it may affect younger men as well. By age 80, more than half of all men have some cancerous growth in their prostate.
Due to routine screening of prostate-specific antigen levels in the United States, nearly 90% of prostate cancers get detected in early stages. In most cases, the cancer is confined only to the prostate and does not spread to other organs. With the widespread use of screening tests in the United States, early diagnosis of prostate cancer has become much easier.
When found early, there are several treatment options available and prostate cancer has a high chance of getting cured. Moreover, prostate cancer is a slow-growing cancer that takes many years to become big enough to cause symptoms. It also takes quite long to spread to other organs. This gives sufficient time for the doctors to treat it.
Oncologists recommend patients to not rush and take some time to understand the various treatment options available after consulting with more than one doctor. Patients can discuss various modes of treatment with the doctor and select the most appropriate option for their prostate cancer.
The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. There are more than three million survivors of prostate cancer in the United States today.
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There Are Different Types Of Treatment For Patients With Prostate Cancer
Different types of treatment are available for patients withprostate cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Locally Advanced Prostate Cancer
Locally advanced prostate cancer is cancer that has started to break out of the prostate, or has spread to the area just outside the prostate.
What are my treatment options?
Treatments for locally advanced prostate cancer will aim to get rid of the cancer, or to keep it under control, depending on how far the cancer has spread.
The treatment options for locally advanced prostate cancer are:
A small number of men may be offered high dose-rate brachytherapy on its own, but this isnt very common.
Choosing a treatment
Depending on how far your cancer has spread, you may have a choice of treatments. If so, your doctor or nurse will talk you through your treatment options and help you choose the right treatment for you. You might not be able to have all of the treatments listed above.
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
Metastatic Or Advanced Prostate Cancer
Prostate cancers that have already spread to other parts of the body usually require treatments that treat the whole body, which includes medications like hormonal therapy, immunotherapy, or chemotherapy. There may still be a role for other treatments like radiation or surgeries to reduce symptoms of the cancer or manage complications.
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How Common Is Ed After Prostate Cancer Treatment
The risk of having ED after prostate cancer treatment depends on a number of factors. People who are younger are less likely to have ED after treatment than those who are older. Your ability to have an erection before surgery or radiation affects whether you will have ED after either of these. People who were able to have and keep strong erections before are more likely to have them after treatment.
The patterns of ED are different after surgery and radiation therapy. But it’s not clear if any treatment offers a better chance of keeping erections. There is no strong evidence clearly showing one is better than any other.
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
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Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.