What Are the Most Effective Treatment Options for Prostate Cancer?
Your doctor will discuss benefits and risks of each treatment
Your doctor will discuss benefits and risks of each treatment
Prostate cancer is the second most common cancer in men in the United States and one of the top causes of cancer deaths among men.
One in eight men will develop it during their lives, mainly affecting those over 65. Black men have a higher risk of getting prostate cancer.
While prostate cancer can be serious, most men who are diagnosed do not die from it. More than 3.3 million men who have been diagnosed with prostate cancer at some point are living in the U.S., according to the American Cancer Society.
Survival rates for prostate cancer have improved largely because of improved screening and treatment. When caught early, the 5-year survival rate is nearly 98 percent.
“Healthy men diagnosed with early-stage prostate cancer have a long natural life expectancy. For many patients, a prostate cancer diagnosis does not require urgent, immediate treatment decisions,” says Ramsey Chichakli, MD, a urologist at Scripps Cancer Center and Scripps Clinic.
Some cancers grow quickly, while others grow slowly. Older men or those with serious health issues and slow-growing cancers may never need treatment.
“Men who have just been diagnosed can often take time to make thoughtful decisions about how to proceed, based on factors like their age and overall health, lifestyle and goals. This is not a one-size-fits-all diagnosis,” Dr. Chichakli says.
What are prostate cancer treatment options?
Your physician will help you weigh the risks and benefits of any prostate cancer treatment approach. Treatment is based on your age, health, cancer stage, if it has spread and potential side effects.
Treatment options range from active surveillance to radiation to surgery. According to Dr. Chichakli, all treatment options are similarly effective.
What is active surveillance?
Active surveillance, also known as watchful waiting, means keeping a close eye on the cancer. It involves several visits per year to the physician for blood tests and examinations that monitor the growth of prostate cancer. Treatment is deferred until or unless the tumor changes from slow growing to more aggressive cancer.
Some men choose this approach to avoid side effects from treatment. Others may feel anxious and think that active surveillance is like doing nothing and prefer a more proactive approach.
Active surveillance may include:
- A prostate-specific antigen (PSA) test and/or digital rectal exam (DRE) every three to six months
- Regularly scheduled imaging tests of the prostate
- A yearly prostate biopsy, or biopsies at shorter intervals
Research has found that 70% of men with early-stage prostate cancer can maintain active surveillance for up to 10 years without needing treatment. If the cancer worsens and you need treatment, your doctor will discuss the best options with you.
Treatment options vary based on your situation and may include:
Hormone therapy
Hormone therapy, also called androgen deprivation therapy, is often used to treat advanced prostate cancer. This treatment lowers male hormone levels in the body, which can help slow the growth of prostate cancer cells. By reducing androgens like testosterone, prostate cancers may shrink or grow more slowly for a while.
Hormone therapy may be recommended if surgery or radiation isn’t an option. This can happen when cancer spreads beyond the prostate or returns after these treatments.
Hormone therapy cannot cure cancer, but it can slow its growth. Other treatments may need to be considered in addition.
Potential side effects of hormone therapy include hot flashes, fatigue, erectile dysfunction and bone thinning. Make sure to discuss these possible side effects with your doctor before beginning treatment.
Prostate surgery
Surgery is often used to treat prostate cancer that has not spread beyond the prostate gland.
Radical prostatectomy – the removal of the prostate gland and some surrounding tissue – is the main surgery for prostate cancer.
The prostate can be removed through open surgery, laparoscopic surgery, or robot-assisted surgery. The type of surgery used depends on various factors, including the surgeon’s expertise, the patient's health and the specific type of prostate cancer.
Open surgery uses a single, long incision to reach the prostate and results in a longer recovery.
Minimally invasive procedures, which use small incisions, have largely replaced open surgery.
In laparoscopic surgery, the surgeon uses a thin tube with a light and camera to see inside the body. The surgeon uses small tools to remove the prostate and nearby tissues.
In robot-assisted surgery, the surgeon controls robotic arms with a panel to precisely move surgical tools. Both minimally invasive methods offer faster recovery, shorter hospital stay and reduced surgery risks.
All surgeries have risks like bleeding, infection, and risks from anesthesia. Prostate surgery carries specific risks, such as losing bladder control and erectile dysfunction. Discuss the benefits and risks of each option with your doctor.
Radiation therapy
Radiation therapy is a common treatment for prostate cancer, killing cancer cells using powerful rays. It is best suited for men whose cancer is confined to the prostate and has not spread to nearby lymph nodes.
Radiation therapy can be used alone or with surgery and hormone therapy. Your doctor will make a plan to target the tumor while shielding nearby sensitive areas from radiation.
Potential side effects include fatigue and urinary or bowel irritation.
Chemotherapy and immunotherapy
Chemotherapy is a treatment that uses drugs to kill cancer cells or slow their growth. It can be used with hormone therapy. It can also be used on its own if hormone therapy isn’t working or if the cancer has spread outside the prostate. It is not usually used for early prostate cancer.
Immunotherapy boosts the immune system to help the body fight cancer. It uses medicines to help recognize and destroy cancer cells more effectively.
Both therapies can cause side effects, including fatigue, nausea and a weakened immune system. As with all treatments, it's important to discuss the potential benefits and risks with your doctor.
Personalized treatment
Every cancer patient is different. What works for one may not work for another. That is why doctors consider personal factors and cancer stages when deciding on a treatment plan.
“With personalized treatment plans, patients can find the most effective treatment for their specific situation,” Dr. Chichakli says.