How Is Prostate Cancer Treated?
Medically reviewed by Gagandeep Brar, MD
Prostate cancer treatment options can include active surveillance, surgery, hormone therapy, and more. Cancer of the prostate begins when cells in the gland change (mutate) and grow out of control, forming a lump or mass called a tumor. Treatment depends on the type and stage of the cancer, your age and overall health, and personal preferences.
The goal of treatment is to either cure the cancer or manage symptoms and prolong life. A multidisciplinary group of healthcare providers called a cancer care team will advise a treatment plan. This team may include a urologist, a radiation oncologist, a medical oncologist, nurses, and other healthcare providers.
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Active Surveillance
Active surveillance is an approach that involves holding off on treatment until there are signs the disease has progressed. Prostate cancer is often slow-growing, and, for some people, the side effects may outweigh the benefits of treatment.
Prostate cancer is considered to be low-risk when the tumor is small and confined to the prostate and does not cause symptoms. It's also considered low-risk when prostate-specific antigen (PSA) blood tests indicate PSA levels below 10.
The tumor will be closely monitored with active surveillance, and treatment will only begin if it grows. A cancer care team will want to see you for frequent check-ups, which may include:
A PSA blood test and digital rectal examination (DRE) every six months
Imaging tests (e.g., transrectal ultrasound) every one to three years
Prostate biopsy every one to three years
Watchful waiting is a term that is often used interchangeably with active surveillance, but the two are different. Watchful waiting is often advised for older adults or people with life-threatening illnesses who may not benefit from prostate cancer treatments.
Follow-up tests to monitor the tumor aren't usually done with this approach. Treatments to manage symptoms may be recommended instead.
Surgery
Surgery is a common treatment approach for prostate cancers that are limited to the prostate gland. This usually involves the removal of the prostate gland and sometimes the seminal vesicles and pelvic lymph nodes. Seminal vesicles are the glands that produce the fluids that eventually turn into semen. Pelvic lymph nodes are the part of the body’s immune system that filters lymphatic fluid.
The type of surgery will depend on the stage of the disease and your overall health. Prostate surgeries have risks and side effects, as with any procedure.
Not everyone experiences these complications, and many are temporary:
Changes in orgasm (e.g., though orgasm is still possible, but ejaculation will not occur)
Difficulty urinating
Loss of fertility
Urinary incontinence, like loss of bladder control
Radical (Open) Prostatectomy
A radical prostatectomy is used when cancer is thought to only be in the prostate gland. It involves the surgeon making an incision in your abdomen from the belly button to the pubic bone. You will be placed under anesthesia so you are not awake and won't feel pain during the procedure.
The surgeon will remove the prostate gland and seminal vesicles once they make the incision. They may also remove lymph nodes in the pelvis.
Laparoscopic or Robotic Prostatectomy
A laparoscopic and robotic prostatectomy are minimally invasive procedures that typically have a short recovery time. The surgeon makes several small incisions in the abdomen during a laparoscopic procedure. They will insert special long instruments, one of which has a small camera on the end so they can see inside your body, to remove the prostate.
Robotic prostatectomy involves the use of robotic instruments to remove the prostate. The surgeon uses a control panel to direct the robotic instruments to perform the surgery and remove the prostate gland.
Transurethral Resection of the Prostate (TURP)
A transurethral resection of the prostate (TURP) procedure is sometimes used to relieve symptoms of prostate cancer, not to cure the disease. A surgeon will insert a narrow tube called a resectoscope into the urethra to cut and remove the prostate or burn away the tissue.
Radiation Therapy
Radiation therapy uses high-energy X-rays to kill cancer cells or prevent them from growing. This may be suggested as a standalone treatment or used in combination with hormone therapy. Different types of radiation therapy for prostate cancer include external-beam radiation therapy and brachytherapy (internal radiation therapy).
Both external and internal radiation therapy can cause side effects. These tend to be mild or moderate and usually resolve once treatment is complete:
Bowel problems such as rectal pain, bleeding, and diarrhea
Erection problems
Fatigue
Urinary problems like frequent urination and pain when urinating
External-Beam Radiation Therapy
External-beam radiation therapy uses a machine outside of the body to focus a beam of X-rays (radiation) on the prostate gland. This type of radiation is often used for early-stage prostate cancer to try to cure the disease or to relieve pain if the cancer has spread to the bones.
Radiation treatments are given five days a week for several weeks. Each treatment takes a few minutes. The time it takes to get you set up for the treatment usually takes longer.
Brachytherapy
Brachytherapy is a form of internal radiation therapy that involves placing radioactive seeds directly into the prostate. These seeds give off radiation to kill off cancer cells when inserted.
Low-dose radioactive seeds work up to a year after insertion and are left in the prostate permanently. High-dose seeds are left in the body for about 30 minutes and may need to be repeated one to four times.
Other Focal Therapies
Focal therapies are minimally invasive prostate cancer treatment options for low- to medium-risk prostate cancers. These may be used in place of surgery and radiation to try to cure prostate cancer.
Cryotherapy
Cryotherapy uses very cold temperatures to freeze and kill cancer cells. A healthcare provider uses transrectal ultrasound (TRUS) to guide and insert probes (needles) through the skin between the scrotum and rectum to reach the prostate. Cold gasses are sent through the probes to freeze and destroy the tumor and prostate tissues.
Side effects of cryotherapy can include blood in the urine, pain in the rectum and bladder, frequent urination, and urinary incontinence. Most side effects are temporary. The freezing process may damage nerves near the prostate that control sexual function and lead to erectile dysfunction.
High-Intensity Focused Ultrasound
High-intensity focused ultrasound (HIFU) uses ultrasound waves to generate heat and destroy cancer cells. HIFU may be less effective than standard treatments. Some people, however, may opt for this treatment before trying radiation therapy or surgery because HIFU is minimally invasive and does not damage healthy areas of the prostate.
Hormone Therapy
Prostate cancer cells use testosterone and other sex hormones to grow. Hormone therapy, or androgen deprivation therapy (ADT), blocks or lowers the amount of sex hormones, essentially starving prostate cancer cells of the fuel they need to survive.
Hormone therapy may be administered surgically, orally, or through injection. Different types include:
LHRH agonists: Luteinizing hormone-releasing hormone (LHRH) agonists are drugs that reduce the amount of testosterone produced by the testicles. These drugs are small implants that are injected or placed under the skin once a month or once every six months.
LHRH antagonists: LHRH antagonists work similarly to LHRH agonists. These drugs lower testosterone levels rapidly and may be given as a monthly injection or taken orally once a day.
Orchiectomy: This is surgical castration that involves the removal of the testicles, where most sex hormones are made. Most prostate cancers stop growing or shrink after the procedure. The effects are permanent and cannot be reversed.
Side effects of hormone therapy include a low sex drive, erectile dysfunction, shrinkage of the penis and testicles, hot flashes, weight gain, fatigue, and loss of muscle mass. These effects are usually short-term and stop once therapy is completed. The long-term risks of hormone therapy include bone loss, heart disease, and diabetes.
Chemotherapy
Chemotherapy (chemo) uses drugs to destroy cancer cells in the body. Chemo is recommended if prostate cancer has spread to other areas of the body. It's not a curative treatment for prostate cancer, but chemo may stop cancer cells from growing and spreading and help people live longer.
Chemo drugs used to treat prostate cancer include:
Emcyt (estramustine)
Jevtana (cabazitaxel)
Novantrone (mitoxantrone)
Taxotere (docetaxel)
Chemo is usually administered via intravenous (IV) infusion, but some drugs are taken orally. Regimens usually involve repeating cycles that include a period of treatment followed by a period of rest.
Side effects of chemo drugs vary depending on the person, the drugs used, and the length of treatment. Fatigue, mouth sores, nausea and vomiting, diarrhea, and bruising or bleeding more easily are common side effects. Most go away once treatment is completed, but some may linger for months or even years. A healthcare provider can prescribe medications to help manage some side effects.
Immunotherapy
Immunotherapy, or biologic therapy, uses medicines that stimulate the body's immune system to attack cancer cells. One type of immunotherapy is called Provenge (sipuleucel-T).
Provenge is a vaccine used to treat advanced prostate cancer that has stopped responding to hormone therapy and causes little to no symptoms. The vaccine does not shrink the tumor, lower PSA levels, or prevent cancer from growing, but it can prolong life.
Provenge is tailored for each person by mixing their white blood cells with an enzyme produced by the prostate called prostatic acid phosphatase. The mixture is then given intravenously every two weeks for a total of three treatments.
Targeted Therapy
Targeted therapy uses drugs that identify and attack specific cancer cells without harming healthy cells. Poly(ADP)-ribose polymerase, or PARP, inhibitors are drugs that block an enzyme that normally helps cells repair DNA damage. These drugs are designed to kill cancer cells by preventing them from repairing their damaged DNA.
PARP drugs may be used if a person has BRCA1 or BRCA2 gene mutations and when other treatments are ineffective. PARP inhibitors are taken orally and may cause side effects such as joint and muscle pain, anemia, and nausea.
PARP inhibitors used to treat metastatic prostate cancer include:
Lynparza (olaparib)
Rubraca (rucaparib)
Clinical Trials
Clinical trials are research studies that test new and potentially better ways to treat the disease. Some people with prostate cancer may choose to participate in a clinical trial to get early access to promising new therapies. Others may join a clinical trial if standard treatments have been ineffective for their cancer.
Talk to a healthcare provider if you are interested in joining a clinical trial. They can help you decide if one is right for you and find one that may be a good fit.
Living With and Managing Prostate Cancer
Prostate cancer and its treatment can impact every part of your life. You may be feeling a wide range of emotions, from shock to fear and from anger to anxiety.
You may feel worried about your health, finances, and the impact your diagnosis has on your family and career. Having support from your family, friends, and cancer care team can go a long way in helping you cope with your diagnosis and treatments.
The good news is that the overall five-year survival rate for prostate cancer is nearly 97%. This rate increases to 100% when the cancer is detected in its early stages. There are many resources available to help you cope with the emotional and physical effects of living with prostate cancer both during treatment and after.
Talk to a healthcare provider about the support available. This may include prostate cancer support groups, financial resources to help cover the costs of treatment, and medications to manage symptoms and side effects.
Related: How Is Ovarian Cancer Treated?
A Quick Review
Prostate cancer treatment options depend on several factors, including the type and stage of the disease, your age, overall health, and personal preferences. Treatment options include active surveillance, surgery, radiation therapy, chemotherapy, immunotherapy, hormone therapy, and targeted therapy.
A cancer care team will recommend treatments to try and cure the cancer if your prostate cancer is discovered in an early stage. Treatments may help stop the cancer from growing and spreading and prolong your life in cases of advanced prostate cancer.
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