Considering Prostate Cancer Treatment Options
For most men diagnosed with prostate cancer, the cancer is found while it’s still at an early stage — it’s small and has not spread beyond the prostate gland. These men often have several treatment options to consider.
Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors such as your age and general health, and the likelihood that the cancer will cause problems for you to consider before deciding what to do. You should also think about the possible side effects of treatment and how likely they are to bother you. Some men, for example, may want to avoid possible side effects such as incontinence or erection problems for as long as possible. Other men are less concerned about these side effects and more concerned about removing or destroying the cancer.
If you’re older or have other serious health problems and your cancer is slow growing , you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symptoms you want to avoid. You may think more about watchful waiting or active surveillance, and less about treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best reason for your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.
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:
Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
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Overview Of Radiation For Prostate Cancer
Radiation therapy has the same cure rate as surgery for prostate cancer that’s localized and locally advanced . This treatment uses high-intensity ionizing radiation, such as X-rays and gamma rays, to strategically pinpoint and destroy cancer cells.
Ionizing radiation is a kind of energy that can pass through living tissue. Low levels of ionizing radiation are used in medical tests such as X-rays and computed tomography scans. Radiation therapy for cancer differs from these common tests in intensity and frequency of use.
Radiation can be used to target cancer cells from outside the body. This technique is called external beam radiation.
Radiation can also be deposited internally in the form of seeds that are placed strategically in the prostate gland. This technique is called brachytherapy . You may be given one or both types of radiation during treatment.
Radiation therapy of either type may be used alone or in conjunction with other treatments. These treatments include surgery and hormone therapy called androgen deprivation therapy, in which levels of hormones that can stimulate the tumor are reduced.
In some instances, the Gleason score may be used as a tool to determine which treatments will be most effective for you. The Gleason score is a diagnostic tool that can help predict the aggressiveness of prostate cancer.
Your doctor may recommend radiation therapy at various stages of treatment, such as:
Side Effects Of Radiation Therapy To Your Prostate
Some people have side effects from radiation therapy. The type and severity of side effects varies from person to person. Your healthcare provider will talk with you about what to expect based on your medical history and specific treatment plan.
This section explains the most common side effects of radiation therapy to the prostate. You may have all, some, or none of these. Most of these side effects will go away several weeks to months after you finish radiation therapy. If you have any of these side effects, your healthcare provider will give you more information and help you manage them.
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Getting Help With Treatment Decisions
Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800-227-2345 or see Find Support Programs and Services.
Itâs important to know that each manâs experience with prostate cancer is different. Just because someone you know had a good experience with a certain type of treatment doesnât mean the same will be true for you.
You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.
Side Effects Of Surgery For Prostate Cancer
The most commonly experienced side effects of surgery for prostate cancer are urinary incontinence and erectile dysfunction.
According to the patient-reported outcomes from men who participated in the ProtecT trial, men who undergo a radical prostatectomy experience more sexual dysfunction and urinary problems than those treated with radiation therapy.
While many reported an improvement in the severity of their symptoms six months after surgery, these men continued to report poorer sexual quality of life six years after surgery compared to those who had radiation therapy.
While men treated with radiation reported experiencing bowel function problems after treatment, the men who had a prostatectomy were generally able to undergo the procedure without experiencing any changes in bowel function after surgery.
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When Is Radiation Therapy Given
Radiation therapy may be used:
- for localised or locally advanced prostate cancer it has similar rates of success to surgery in controlling prostate cancer that has spread to the lymph nodes
- if you are not well enough for surgery or are older
- after a prostatectomy for locally advanced disease, if there are signs of cancer left behind or the cancer has returned where the prostate used to be
- for prostate cancer that has spread to other parts of the body.
There are two main ways of delivering radiation therapy: from outside the body or inside the body . You may have one of these or a combination of both.
In intermediate and high-risk prostate cancer, radiation therapy is often combined with androgen deprivation therapy .
How To Decide Between Radiation Or Surgery For Prostate Cancer
If you want to know how to decide between radiation or surgery for prostate cancer, youve come to the right place.
Prostate cancer is the second most common cancer in men, with more than 1 million cases diagnosed in 2018. It often grows slowly so that most men die of other causes before it becomes clinically advanced and hard to treat.
As most prostate cancers are diagnosed in slow-growing stages, they usually do not require immediate treatment decisions.
For localized and locally advanced prostate cancers, surgery and radiation therapy are the main treatment options.
Both options have risks, including erectile dysfunction, urinary problems, and bowel complications.
Your doctor will use the results of your diagnostic tests to balance the treatment benefits against those side effects.
Here, we explore the suitability of different treatment options. Well help you understand how to decide between radiation or surgery for prostate cancer. We offer information to help you consider the best treatment for your specific disease.
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What Are The Treatments For Localized Prostate Cancer
- Surgery takes out the prostate and any nearby tissue that may contain cancer, including lymph nodes. This surgery is called a radical prostatectomy . A doctor can do it as open surgery by making a cut, or incision, in your belly or groin. Or he or she can do laparoscopic surgery by putting a lighted tube, or scope, and other surgical tools through much smaller cuts in your belly or groin. The doctor is able to see your prostate and other organs with the scope. In some places, robot-assisted laparoscopic prostatectomy may be done. In this type of surgery, the surgeon controls the robotic arms that hold the tools and scope.
- Radiation uses X-rays and other types of radiation to kill the cancer cells. This may be done with:
- External-beam radiation, in which a machine aims high-energy rays at the cancer.
- Brachytherapy , in which tiny pellets of radioactive material are injected into or near the cancer.
- Both kinds of radiation.
Radiation and surgery are treatments that destroy or remove localized prostate cancer. Both treatments also have long-term side effects, like bladder, bowel, and erection problems.
In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment.footnote 3
Follow-up treatment
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.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
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 Options: When Cancer Returns After Radiation
After prostate cancer is treated, patients usually undergo a blood test called PSA. PSA stands for Prostate Specific Antigen and is a simple blood test that gives a number. After treatment, that number should be low. If it starts to increase, that can be a signal of cancer coming back, also known as cancer recurrence.
Often doctors will watch a series of PSA values to identify the trend. If the PSA number continues to increase, this is called biochemical failure, and your doctors will investigate the cause. Sometimes doctors will order scans to see if there is cancer recurrence locally , or distantly . Treatment is different depending on where the cancer is found.
If there is high suspicion for local recurrence, your doctors may encourage a prostate biopsy to see if there is tumor identified under the microscope. If so, there are several local treatment options including cryotherapy and prostatectomy. Some patients may choose observation.
Brachytherapy Option
What about using brachytherapy on the prostate? This has not been as popular given the concern about risk of toxicity for patients who have used external beam radiation previously
More follow up is needed and the complete results will be reported with longer follow up, but this study shows that salvage brachytherapy may be another option in the treatment of recurrent prostate cancer after radiation therapy.
Sexual And Reproductive Health
You can be sexually active during your radiation therapy, unless your radiation oncologist gives you other instructions. You wont be radioactive or pass radiation to anyone else.
If youre sexually active with someone whos able to get pregnant, its important to use birth control during and for 1 year after your radiation therapy. During your radiation therapy, your sperm may be damaged by the radiation. If you conceive a baby with this sperm, the baby might have birth defects. Using birth control helps prevent this.
For more information about your sexual health during cancer treatment, read Sex and Your Cancer Treatment. The American Cancer Society also has resources about sexual health issues during cancer treatment. The one for men is called Sex and the Adult Male with Cancer. You can search for it at www.cancer.org or call for a copy.
Male Sexual and Reproductive Medicine Program
MSKs Male Sexual and Reproductive Medicine Program helps people address the impact of their disease and treatment on sexual health. You can meet with a specialist before, during, or after your treatment. We can give you a referral, or you can call for an appointment.
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How To Compare Radiation Vs Surgery For Prostate Cancer
Research from the ProtecT trial shows us that radiation and surgery are good options, with the caveat that the specifics of your personal health condition could make one more advisable than the other. If thats not the case, rest assured that youre not at risk of making a terrible decision: Radiation and surgery are both solid options.
How to evaluate radiation vs. surgery comes down to understanding the disease and the research on treatment outcomes, getting a thorough understanding of your specific situation and then deciding which pathway you feel is right for you.