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What Are Treatment Options For Prostate Cancer

Considering Prostate Cancer Treatment Options

Treatment Options for Localized Prostate Cancer – Urology Care Foundation

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.

Side Effects Of Targeted Therapy

Some men may experience side effects such as diarrhea, nausea and low red blood cell counts. Other possible side effects include:

Liver blood tests may also be abnormal.

One of the targeted therapies for prostate cancer, Lynparza® , may increase the risk for blood clots in the lungs and legs. These drugs may also cause a blood cancer such as myelodysplastic syndrome or acute myeloid leukemia, but this is rare.

Are There Side Effects

The treatments for prostate cancer also can affect your body in other ways. Side effects can include:

  • Loss of your ability to get a woman pregnant
  • Leaky bladder or loss of bladder control. You might also need to pee a lot more often.

Side effects are another thing to think about when youâre choosing a treatment. If theyâre too tough to handle, you might want to change your approach. Talk to your doctor about what you can expect. They can also help you find ways to manage your side effects.

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The Johns Hopkins Proton Therapy Center

Proton therapy is used to treat certain tumors in children and adults. Our treatment center, located at Sibley Memorial Hospital in Washington, D.C., combines advanced proton therapy technology, the latest research and caring specialists.

A combination of several treatments, including surgery, radiation therapy or hormone therapy, may be used to treat prostate cancer. The medical team will provide a comprehensive assessment of available treatments as well as expected outcomes. The treatment decision will be based on a number of clinical and psychological factors, including the patient’s cancer stage, need for therapy, level of risk, anticipated life expectancy, overall health and personal preference.

When it comes to prostate cancer treatment, timing is often just asimportant as the type of treatment chosen. Some patients select activesurveillance or watchful waiting to delay treatment and avoid the associated risks and side effects.

What Is Stereotactic Body Radiation Therapy And What Advantages Does It Offer

Prostate Cancer

Stereotactic body radiation therapy, or SBRT, involves the use of sophisticated image guidance that pinpoints the exact three-dimensional location of a tumor so the radiation can be more precisely delivered to cancer cells. Traditionally, external beam radiation has been delivered in anywhere from 45-48 sessions over multiple weeks. But large, randomized studies have shown that shorter courses of radiation are just as safe and effective. Therefore, at MSK, we have shortened all our radiation courses.

There is increasing interest in giving this radiation in very short courses of treatment using intense radiation doses, called hypofractionated radiation therapy. Many of the people we care for have a type of radiation therapy called MSK PreciseTM. This is a hypofractionated form of SBRT that can be given in five sessions. MSK has been doing this for the past 20 years, and the results in the several hundred people whove been treated have been excellent so far. The treatment is very well tolerated and quite effective

Because of its superior precision, MSK Precise can have fewer side effects than more conventional radiation techniques, with extremely low rates of incontinence and rectal problems. The sexual side effects are low, similar to what is experienced with more extended external radiation techniques. And of course, its much more convenient for patients.

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Questions To Ask The Health Care Team

After you learn about your treatment options and your general health, you might need more information. Consider asking your health care team the following:

  • Is my cancer curable?

  • What is my chance of recovery?

  • What are all of my treatment options?

  • What is the goal of each treatment?

  • What treatment do you recommend? Why?

  • How does this treatment help me?

  • What are some risks and potential side effects of this treatment?

  • Will I need to be in the hospital for treatment? Or can I stay home and come to the hospital or clinic during the day?

  • How long will each treatment last?

  • How will this treatment affect my daily life? Will I be able to perform my usual activities?

  • If I am worried about managing the costs related to my cancer care, who can help me with these concerns?

  • How can I keep myself as healthy as possible during treatment?

  • If I have questions or problems, who should I call?

  • What support services are available to my family?

Hormone Therapy For Prostate Cancer

Male sex hormones, mostly testosterone, provide the fuel that drives prostate cancer growth. The goal of hormone therapy is to deprive prostate cancer cells of that fuel. Hormone therapy is used to treat advanced prostate cancer, but it can also be used to shrink larger tumors, making other treatments easier. Hormone therapy does not kill cancer cells but can significantly shrink tumors and slow any further growth. Side effects include loss of sex drive, impotence, nausea, diarrhea, and fatigue. Hormone therapy takes three forms:

ADT or androgen deprivation therapy. These medications are injected into the buttocks either once a month, once every three to four months, or once a year, depending on the specific drug. If these treatments are used instead of surgery, these drugs must be administered regularly for life.

Anti-androgens prevent prostate cancer cells from using testosterone. They are given in pill form. This type of therapy is not given by itself. It is used in combination with surgery or other hormonal therapies.

Orchiectomy involves the removal of the testicles, which reduces testosterone production by about 90%. This approach is sometimes chosen by older men who do not want the inconvenience or expense of taking medications. Silicone implants are placed within the testicular sac to preserve a natural look.

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Choosing The Best Treatment

It can be difficult to choose the best treatment for you. Your doctor and specialist nurse will explain the different treatment options and help you make a decision. The Predict Prostate tool can also help you decide between monitoring and radical treatment. We have more information about this tool further down this page.

A UK trial showed that there can be very little difference in survival between the treatments especially if you are diagnosed with early prostate cancer.

The table below shows how many men survive different treatments for CPG 1, 2 and 3 localised prostate cancer after 10 years.

Treatment

Treatment By Stage Of Prostate Cancer

Treatment options for early (localised) 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.

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What Treatments Are Available

If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.

If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.

If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.

Before you start treatment

Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.

It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.

If you have any questions, speak to our Specialist Nurses.

Genetic Testing For Prostate Cancer

You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.

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What Affects My Treatment Options

Your treatment options will depend on whether your cancer is contained within the prostate gland , has spread just outside of the prostate or had spread to other parts of the body .

You may have a choice of treatments. Your doctor or specialist nurse will explain all your treatment options, and help you to choose the right treatment for you.

Your treatment options and which treatment you choose may depend on several things, including:

  • how far your cancer has spread
  • how quickly your cancer may be growing
  • the advantages and disadvantages of each treatment
  • what each treatment involves
  • the possible side effects of each treatment
  • practical things, such as how often you would need to go to hospital, or how far away your nearest hospital is
  • your own thoughts about different treatments
  • how the treatment you choose now could affect your treatment options later if your cancer comes back or spreads
  • your general health
  • how long youre expected to live for.

The first treatment you have may affect which treatments you can have in the future, if you need further treatment. Speak to your doctor or nurse about this.

It can help to write down any questions you want to ask at your next appointment. And to take someone to appointments, such as your partner, friend or family member.

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If You And Your Family Do Not Agree

Urology

Family members, friends, and caregivers might have different ideas about your treatment. They might want you to have more aggressive treatment. Or they might try to keep you from having certain treatments.

If this happens, your health care team can help you talk with your family and friends. Sometimes, it is best if your family and closest friends meet with you and your doctor to talk about the best treatment plan. Remember that you always have the right to make your own treatment decisions.

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Treatment Of Local Events

Both the disease and its treatment can give rise to troublesome and serious consequences it is important to take these into account and to inform the patient about them early on.

Skeletal pain can be treated with palliative radiation therapy, steroids and opiates. An MRI examination should be performed promptly upon suspicion of impending spinal cord injury. If confirmed, treatment consists of immediate administration of high dose steroids combined with surgery and/or radiation therapy .

Skeletal-related events may be prevented with zoledronic acid or denosumab . Dosing intervals and when to initiate treatment are poorly defined, but common practice is to administer treatment every three months, beginning when symptomatic skeletal metastases are present. The patient should be examined by a dentist prior to use of zoledronic acid or denosumab, as there is a risk of osteonecrosis in the jaw bone . Calcium and vitamin D supplements should be taken during treatment .

Obstruction of the urinary tract or bowel may be relieved by palliative surgery, drainage or radiation therapy. Surgery, radiation therapy or embolisation may be appropriate in the event of haemorrhage.

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What Are The Symptoms Of Prostate Cancer

Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:

  • Frequent, sometimes urgent, need to urinate, especially at night.
  • Weak urine flow or flow that starts and stops.
  • Painful urination .
  • Lower back pain, hip pain and chest pain.
  • Leg or feet numbness.

Chemotherapy For Prostate Cancer

Prostate cancer treatment options

The decision on when to start chemotherapy is difficult and highly individualized based on several factors:What other treatment options or clinical trials are available.How well chemotherapy is likely to be tolerated.What prior therapies you have received.If radiation is needed prior to …

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Considering Complementary And Alternative Methods

You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.

Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.

When To Call A Doctor

  • You cannot urinate.
  • You have groin or belly pain.
  • You have pain in your back or hips.
  • Your pain isn’t controlled.
  • You are vomiting or nauseated.
  • Watch closely for changes in your health, and be sure to contact your doctor if:

    • You have trouble starting or controlling your urine.

    If you have been diagnosed with cancer, be sure to follow your doctor’s instructions about calling when you have problems, new symptoms, or symptoms that get worse.

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