Prostate Cancer – Treatment Options For Men With Prostate Cancer
Men with prostate cancer have many treatment options. Your cancer care team will help you choose the right option.
A biopsy is when a doctor takes a small sample of the prostate and checks it for cancer cells. A doctor will also examine your PSA levels and medical imaging to find out how advanced the cancer is. This is called staging.
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Prostate cancer develops in the prostate, a small walnut-shaped gland located below the bladder and in front of the rectum in men and people assigned male at birth (AMAB). The prostate secretes fluid that mixes with semen, keeping sperm healthy for conception and pregnancy. Most cases of prostate cancer are adenocarcinomas.
The early stages of prostate cancer rarely cause symptoms and may go undetected for years, which is why screening is so important. Symptoms only appear when cancer has progressed to later stages. These symptoms can include frequent, urgent need to urinate, painful urination or loss of bowel control (urinary incontinence), back or hip pain, or unexplained weight loss.
Advanced prostate cancer may also cause swelling in the groin or pelvic area, sore lymph nodes in the groin, or pain in the ribs or bones. It may also lead to erectile dysfunction, which makes it hard for you to get or keep an erection (impotence). If your prostate cancer spreads to the bones, it can crowd out healthy bone tissue and make the bones brittle. This can lead to back or hip pain, which may worsen over time.
Hormone therapy can be used to treat early prostate cancer and to help reduce the chance of the cancer coming back after radiotherapy or surgery. However, it is not usually used to treat prostate cancer that has spread to other parts of the body.
Some treatments, such as high-intensity focused ultrasound or cryotherapy, can be used to treat prostate cancer without the side effects of surgery, radiation therapy or hormone therapy. However, these treatments are new and they have not been tested long enough to know how well they work.
Many things can increase your risk of prostate cancer, including age and family history. Your risk is higher if a close relative has had the disease or if you have a family history of hereditary cancer syndromes. It is also more likely to occur in African American men and less often in Asian American and Hispanic/Latino men.
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Your care team will use medical exams and lab tests to check for prostate cancer. These include a blood test to measure your PSA level and a digital rectal exam (DRE). A DRE involves inserting a probe with a camera into the rectum to feel the area. A urologist might also do an ultrasound of the prostate. A specialized type of MRI called an MRI using an endorectal coil can help get better images of the prostate.
If the biopsy shows that you have prostate cancer, your doctor will need to know what stage it is in order to decide which treatment is best. The staging system describes how much and how quickly the cancer is growing. It is based on the Gleason score, PSA levels and what medical imaging shows.
A biopsy is a procedure that removes some of the cancer cells for examination under a microscope. Your doctor may do a transurethral biopsy (TURP) or a transrectal biopsy to collect tissue samples from the prostate. The doctor will give you a sedative or muscle relaxant to make you comfortable during the procedure.
Other tests can help find out if the cancer has spread. They might include a CT scan or an MRI of the pelvis with a lymph node map. Lymph nodes are small bean-size structures that act as filters for the immune system. The cancer can sometimes break away from the prostate and spread to these lymph nodes.
The diagnosis will also be based on whether your symptoms are bothering you. Some people with prostate cancer do not have any symptoms and their doctors might choose to watch the disease instead of treating it right away. This is known as active surveillance. It includes regular PSA testing and a blood test to check for other health problems.
Your care team will treat your prostate cancer with surgery, radiation or hormone therapy. Hormone therapy lowers the levels of androgens in your body, which help cancer cells grow. It can be given by pill, shot or implant. Chemotherapy uses drugs to kill cancer cells or prevent them from growing. It might be used before other treatments to shrink the tumor or after surgery and radiation therapy to lower the chance that the cancer will come back.
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The treatment options for prostate cancer depend on whether the cancer is contained within your prostate (localized) or has spread to other parts of your body (advanced). Your doctor and nurse will explain all the treatments and help you choose the one that’s right for you.
If the cancer hasn’t spread, your doctor may recommend watchful waiting, which means you won’t have treatment unless it grows or causes symptoms. Your doctor will monitor your condition with regular screenings, scans and biopsies. You’ll also have tests to see how your body responds to treatment if you decide to go with active surveillance.
Surgery to remove your prostate may be an option if your cancer hasn’t spread. Your doctor may only remove your prostate gland or remove it along with some surrounding tissue. Surgery can cause side effects like problems controlling your urine and trouble getting or keeping an erection.
Radiation therapy uses high energy to kill or prevent cancer cells from growing. It may be delivered from outside your body (external beam radiation) or inside your body using small radioactive seeds (brachytherapy).
Hormone therapy blocks the hormones that prostate cancer cells need to grow. It’s usually given in combination with other treatments, such as external beam radiation or chemotherapy.
Chemotherapy drugs use drugs to kill cancer cells or stop them from dividing. They’re often given with other cancer treatments, such as a steroid or a vaccine to boost the immune system. They’re also an option for advanced prostate cancer that doesn’t respond to hormone therapy.
Some doctors are studying new ways to treat prostate cancer. These include helping your immune system cells recognize and attack cancer cells or blocking the actions of certain hormones that promote cancer growth. These experimental drugs aren’t available yet for general use.
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Prostate cancer happens when cells in the prostate gland grow faster than normal, forming a mass called a tumour. Over time, the tumour can also spread to other parts of the body, such as the bones or lymph nodes.
A prostate cancer diagnosis can be scary, but it is usually not life-threatening. Most people with early-stage prostate cancer do not experience any symptoms. Some men with advanced disease may have urination problems such as leakage of urine (urinary incontinence) or a need to urinate frequently or urgently. However, these symptoms can be caused by other conditions, such as benign prostatic hyperplasia (BPH), which also needs to be treated.
If you do have symptoms, they may be mild and get better after treatment. Most patients with prostate cancer receive either surgery or radiotherapy. Both treatments can cause side effects. The type and severity of the side effects will depend on what part of the prostate is affected and how far the cancer has spread.
Your doctor will advise you about the potential side effects of your treatment. You can help to reduce the chance of side effects by following your doctor’s advice, such as eating a balanced diet, being active, avoiding smoking and excess alcohol and getting plenty of rest.
Some of the most common side effects of treatment include a temporary decrease in sex drive and problems with urinating, such as urinary incontinence or trouble controlling how quickly you empty your bladder. These side effects can last a few weeks or months and may be permanent in some cases.
Radiation therapy can damage sperm in the testicles and reduce semen production, which can affect fertility. It is important to discuss this with your doctor before beginning treatment, especially if you want to have children in the future. Options to preserve fertility include banking sperm before starting treatment and using artificial insemination if you require hormone treatment.
After you finish treatment, your doctor will check your health and manage any long-term side effects. You will have regular PSA tests, MRI scans and biopsies to make sure the cancer has not come back.
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Men often do not have any symptoms when prostate cancer is in its early stages. When a man does have symptoms, they can include:
Frequent, sometimes urgent, need to pee. Pain or burning when you pee. Weak urine flow that starts and stops. Loss of bladder control (urinary incontinence). These symptoms are also common for noncancerous conditions like an enlarged prostate or urinary infection.
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Erectile dysfunction (ED) and reduced libido are common side effects of prostate cancer treatment. They can be caused by surgery, radiation therapy and hormonal treatments that reduce male hormones called androgens. Some men also experience problems with urinary incontinence and bowel function. Many men find these issues embarrassing to discuss with their doctor, but early intervention and support can help them cope.
If you have prostate cancer, your symptoms may not start until the prostate grows large enough to affect the urethra, the tube that carries urine from the bladder to the penis. Your prostate may get larger due to a noncancerous condition known as benign prostatic hyperplasia, or from aging. As the prostate grows, it can squeeze nerves that control erections, and can also cause painful or weak erections.
Other symptom of prostate cancer is a sudden loss of sexual interest, even with your spouse or partner. This symptom often occurs after the diagnosis of cancer and the initial treatment. It can be difficult to pinpoint the reason for this symptom, but it may be related to the stress of a cancer diagnosis and the fear of the impact on your sex life.
Many people with prostate cancer choose to use hormone therapy, which lowers androgen levels and slows the growth of tumors. Hormone therapy is an important part of most prostate cancer treatment plans, and it can have a significant impact on sexual performance. ED is the most common complication of this treatment.
For some men, a lack of erections is more serious than others. For some, the onset of erectile dysfunction is relatively short-lived, and they are able to achieve erections again shortly after completing their prostate cancer treatment. For other men, a period of time that lasts a month or longer is typical, and they are unable to have an erection at all.
Some men are able to restore their erections through medication, lifestyle changes and psychosexual counseling. Other strategies include pelvic floor exercises, vacuum erection devices and surgically implanted penile implants. If your erectile problems persist, talk to your doctor.
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Back pain is a common symptom of prostate cancer, but it can also indicate other medical conditions. The back consists of bones, nerves, and muscles, so any problems with any of these structures can cause pain. For example, the discs that are located between the vertebrae of the spine can become damaged. This may lead to compression of the spinal cord, which can cause back pain. Other causes of back pain include inflammation, slipped disc, arthritis, and herniated disks.
If you have back pain that doesn’t go away, talk to your doctor. He can recommend treatment options, such as surgery or physical therapy, to help ease the pain. You can take pain-relieving medications, such as ibuprofen or naproxen, to manage the pain. If the pain is severe, you should seek emergency care.
Prostate cancer can spread to the bones of the spine. This is called metastasis. It isn’t as common as other symptoms of prostate cancer, but it can occur. It can be painful and can cause back stiffness and headaches.
Symptoms of back pain from prostate cancer can vary in severity, type, and duration. You may have pain in the lower or upper back, pelvis, or thigh area. You might have a dull or stabbing pain that is ongoing or comes and goes. The pain can be mild or severe and can be felt when you move, sit, or stand.
In some cases, back pain from prostate cancer can be accompanied by urinary tract issues. You might experience a sudden urge to urinate or lose control of your bladder. The pain can be mild or severe and is sometimes accompanied by burning sensations when you urinate.
If you are experiencing a change in your bathroom habits, talk to your doctor. It could be a sign of prostate cancer, especially if the changes happen quickly. You might wake up in the middle of the night to use the bathroom, or you may suddenly have a weak urine stream.
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If you’re experiencing pain in your lower back, pelvis or thighbones that doesn’t go away, it may be prostate cancer. You also might have burning or sharp pain that follows a nerve path and comes and goes. This type of pain is called neuralgia (noo-RAL-jah). It occurs when there is a problem with a nerve or nervous system. This type of pain can occur in your legs or arms, but is most common in the lower back and pelvis. It can happen anywhere in the body, but is more likely to occur in people who are over age 60.
Urinary tract problems can be a sign of prostate cancer, but they can also be caused by other things, such as an infection or benign prostatic hyperplasia (BPH). If you suddenly have to urinate more often or feel like your bladder doesn’t empty completely, this could indicate a problem with your urinary system or prostate cancer. If you have to urinate frequently, it can cause a backflow of urine into the scrotum and your penis.
A doctor can check your urination patterns by performing a digital rectal exam, which involves inserting a lubricated gloved finger into the rectum. This can help a doctor feel for any changes in size, consistency or nodularity of your prostate gland and help determine whether you have prostate cancer or another condition.
In some cases, your doctor may choose to monitor the condition instead of starting treatment if the cancer is growing slowly and hasn’t spread beyond the prostate. This is called active surveillance and typically consists of getting screenings, scans and biopsies every one to three years.
You might need treatment that kills cancer cells or stops them from dividing, which is known as chemotherapy. Your doctor may give you chemotherapy pills or inject you with chemo directly into the bloodstream. Those drugs might reach cancer cells throughout the body, or they might only target cancer cells in your prostate.
Certain treatment options can lead to urinary incontinence, erectile dysfunction or bowel problems. Ask your doctor about these side effects before you begin treatment. You can also get information about these treatments by talking to other survivors and researching the skill and reputation of doctors in your area.
Oren Zarif
A loss of appetite is a common prostate cancer symptom. However, it may be caused by other health conditions or medications, so it’s important to talk to your doctor about your symptoms and find out what’s causing them. Your doctor will ask about your eating habits, and may recommend that you keep a food diary for a few days to a week. If you are losing weight, your doctor may refer you to a dietitian for advice on healthy eating.
If you’re worried about a loss of appetite, you can try to eat more protein and calories. Your doctor may also suggest that you drink a lot of water, and make sure that you eat snacks between meals. You can also try adding spices to your food, or making smoothies with a high concentration of protein. If you still can’t eat, your doctor might suggest that you have liquid nutrients delivered through a tube (tube) into your stomach (IV).
Some people don’t have any symptoms of prostate cancer at all. Others have mild symptoms that can affect their daily lives, such as trouble passing urine or erectile problems. If you have symptoms, they are likely to get worse as the cancer gets bigger.
Your doctor will start by asking you about your symptoms and how long they have been there. They’ll also want to know what effect they are having on your life. This information will help them decide which tests you need.
Several tests can be used to check for prostate cancer, including a blood test to measure PSA levels. These can help your doctor to decide if the prostate is growing too fast and needs treatment.
Another test is called digital rectal examination (DRE). Your doctor or a nurse will put a gloved finger into your rectum to feel your prostate gland. It’s a quick and painless test. Your doctor can also check for signs of cancer in your prostate using a procedure called fine needle aspiration (FNA). They will use a thin needle and syringe to remove a small amount of fluid or cells from the prostate. They might also do a transrectal ultrasound-guided biopsy (TRUS biopsy). This uses sound waves to build pictures of your prostate, and a special tool to pass a needle through your rectum and remove tissue or cells for testing in the lab.
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There are several treatment options for prostate cancer. Some are standard of care while others are available through clinical trials.
All treatments can cause side effects. Some side effects may become worse over time, such as urinary or bowel problems.
Some treatments are able to stop or slow cancer cell growth. These include a prostate cancer vaccine and drugs that prevent the body from making testosterone.
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Surgery is a treatment option for Prostate Cancer that hasn’t spread beyond the prostate (localised). It can also help manage symptoms. The type of surgery you have depends on how far the tumour has spread. You may need to have a combination of treatments.
Your surgeon will remove the tumour, as well as some surrounding tissue. They will use anesthesia to stop you feeling pain during the operation. This can be general anaesthesia or a spinal anaesthetic. If they need to do a radical prostatectomy, they will use more anaesthesia.
You can get radiation therapy to shrink or kill any remaining cancer cells after surgery. It can be delivered from outside your body using a machine that directs high-energy rays at the area of your prostate (external beam radiation therapy) or inside your body using small radioactive “seeds” placed near the tumour in a procedure called brachytherapy. Radiation can cause side effects like erectile problems and bladder control issues. But these often improve after the treatment finishes.
Hormone therapy isn’t a treatment for prostate cancer itself, but it can reduce your risk of the tumour growing by stopping your prostate gland producing testosterone. It can be given with other treatments or on its own.
Your doctor will explain all your options and help you choose the best treatment for you. They will talk to you about your health and lifestyle, as well as how the different treatments might affect you. It’s important to take your time making this decision. You might want to ask for recommendations from friends and family. Or you might want to consider taking part in a clinical trial. You could find out about trials from your doctor or the National Cancer Institute’s website.
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Radiation therapy uses high-powered X-rays or protons from outside the body to kill cancer cells and shrink tumors. It’s usually given in a hospital outpatient setting over five days or weeks. During the treatment, you lie on a table while a machine moves around your prostate and directs radiation to it from different angles. Your doctor will plan your treatment to limit the amount of radiation that goes to healthy tissue nearby. Radiation can cause side effects like urinary incontinence, bowel problems and trouble getting or keeping an erection. Your doctor can give you medicine to help manage these side effects.
A biopsy is done to find out if you have prostate cancer and its grade (Gleason score). It’s also used to monitor your cancer and decide on the best treatment.
Your doctor may suggest watchful waiting if you have low- or very low-risk localised prostate cancer that hasn’t spread. This involves having regular blood and digital rectal examinations to check for changes in your PSA level and your general health. Your doctor will check your cancer with other tests, such as a PSMA PET scan or transrectal magnetic resonance imaging (MRI).
Immunotherapy is an option for advanced prostate cancer that no longer responds to hormone therapy. It works by helping your own immune system cells to recognise and attack cancer cells. This type of treatment can be given with other medicines or alone. One example is sipuleucel-T (Provenge).
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The information that doctors use to decide the best treatment for prostate cancer depends on the size of the tumor and whether it has spread to other parts of the body. Doctors learn this by using a system called TNM (Tumor, Nodes, and Metastasis) to rate the cancer’s severity. They also look at PSA levels and the Gleason score to help them make a diagnosis.
Most prostate cancer grows slowly, so some doctors may recommend watchful waiting instead of surgery. This means you will have regular PSA tests and a prostate biopsy. Your doctor will treat the cancer only if it gets bigger or causes symptoms.
If your cancer has spread, chemotherapy drugs may be used alone or in combination with other treatments. They can help relieve symptoms and extend your life. These drugs can be taken as pills or given through a vein (intravenously, or IV) infusion. They work by blocking the production of testosterone, which makes prostate cells grow.
For advanced prostate cancer, doctors sometimes give chemotherapy drugs with radiation to kill more prostate cancer cells. This is called neoadjuvant therapy. The chemotherapy drug docetaxel (Taxotere) is most often used in this setting, with or without prednisone. This drug can extend the lives of men who have cancer that has not responded to hormone therapy.
Another treatment option is focal therapy. It involves placing a special probe in or near the prostate to freeze and destroy the cancer cells. This treatment is under study for its effectiveness in avoiding side effects, such as erectile dysfunction and bladder control problems. Focal therapy targets small tumors and uses lower doses of chemotherapy than traditional approaches.
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Bisphosphonates are drugs that bind to bone and suppress its breakdown. They have become the primary therapy for conditions characterized by excessive bone resorption (e.g., postmenopausal osteoporosis, Paget disease of bone, inflammatory bone disorders, hypercalcemia and malignancies that metastatic to the bone).1,2 Bisphosphonates function by binding to the hydroxyapatite crystals within the bone and inhibiting their breakdown. The long side-chain (R2) of bisphosphonates selectively inhibits the activity of farnesyl pyrophosphate synthase, an enzyme in osteoclasts that metabolizes pyrophosphate into hydroxyapatite. This inhibition promotes apoptosis of the osteoclast, while simultaneously decreasing the rate at which hydroxyapatite is converted to calcification.
In healthy bones, specialized cells that form and shape bone break down old bone tissue and build new bone at the same time. This balance between bone break down and building is called bone remodeling. Cancers that spread to the bones can disrupt this process by stimulating the cells that break down bone, called osteoclasts. As the cancer cells grow, they cause more and more osteoclasts to break down bone, leading to less new bone being formed and releasing more calcium into the blood than normal.
Bisphosphonates slow this breakdown and increase bone mass, which lowers the risk of fracture. They also reduce the pain and damage caused by cancer treatments that affect the bones. Bisphosphonates may be given by mouth in pill form or by intravenous (IV) infusion, usually every 3 to 4 weeks. IV infusions can cause flu-like symptoms, such as tiredness and aches and pains. These can be reduced by taking acetaminophen (Tylenol) before and after the infusion. Low blood calcium levels are more likely to happen when taking IV bisphosphonates, so your doctor will check your blood levels while you are receiving them.
High-Intensity Focused Ultrasound
A type of ultrasound treatment, this procedure directs high-intensity sound waves to a targeted area of your prostate tissue. This heats and destroys the cells in that area of your prostate. It can also be used to treat pain caused by prostate cancer that has spread to your bones. The HIFU machine is similar to those used for diagnostic ultrasound, but it emits much higher-intensity sound waves. It focuses them at a specific point in your prostate and only targets the abnormal tissue—much the way a magnifying glass can focus sunbeams to burn a hole through paper.
At MSK, doctors have developed an advanced form of HIFU that’s guided by magnetic resonance imaging (MRI). This technique, called MR-guided focused ultrasound or MRgFUS, allows them to target the specific areas of your prostate where cancer is growing and avoid healthy tissues like the urethra, which is the tube you urinate through.
During HIFU, the urogynecologist inserts the ultrasound probe into your rectum. It makes images of your prostate and other parts of your body while you lie down. They use these images to guide the HIFU probe to your prostate, which is surrounded by a cooling balloon that protects the urethra and other important tissues from the sound waves.
This procedure is usually done in the hospital as an outpatient. After you’re put under anesthesia, the urogynecologist moves the HIFU probe around your prostate and delivers several treatments. Each treatment lasts for a few seconds and targets an area of your prostate smaller than the size of a grain of rice. The entire procedure usually takes about 3 hours. You may experience some discomfort, but it’s usually well tolerated.