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Prostate Cancer Treatment

The Four Standard Types of Treatment for Prostate Cancer

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Updated July 03, 2014

Spain, Basque Country, Gipuzkoa, San Sebastian, Hospital Donostia, Prostate surgery
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After your prostate cancer has been diagnosed, staged, and graded, your physician will evaluate the unique characteristics of your cancer as well as your general health in order to suggest a prostate cancer treatment plan.

Four standard treatment options are widely available today. One or more of these may be selected by you and your physician once the pros and cons of each are carefully weighed. Additionally, a number of less common treatment options are available.

  1. Surgery

    The primary goals of surgery are to remove the cancerous tissue from the body, to remove other structures that may contain cancer (such as lymph nodes), and to minimize damage to any normal, cancer-free tissues and organs that are nearby.

    Radical Prostatectomy – The prostate, some surrounding tissue, and the seminal vesicles are all completely removed. This is, by far, the most commonly chosen type of surgery for prostate cancer.

    This surgery can be completed by entering the body from two different sites:

    • Retropubic Radical Prostatectomy – The initial incision (cut) by the surgeon is made in the lower abdomen between the navel and just above the penis. From this site, lymph nodes near the prostate can also be removed and examined for evidence of cancer.

    • Perineal Radical Prostatectomy – The initial incision (cut) by the surgeon is made in the skin between the anus and scrotum. From this site, lymph nodes cannot be removed, so a second incision is sometimes needed in the lower abdomen to remove them.

    Possible Surgical Sites


  2. Radiation Therapy

    Radiation therapy consists of the use of high energy x-rays to kill cancer cells. Radiation works by damaging the DNA that is needed by cells to grow and divide.

    Radiation is focused in such a way as to damage and kill as much of the cancer as possible, while minimizing the amount of healthy nearby tissue that is affected.

    Radiation can be delivered to the area of cancer in two primary ways.



  3. Hormonal Therapy

    Male sex hormones, such as testosterone, are produced naturally within the body. Prostate cancer can grow in response to these hormones, so therapy to block the production or effects of these hormones is sometimes used.

    A number of different medications have been developed to accomplish this. Hormonal therapy is sometimes used alone, but it is more often used in combination with other treatments such as radiation.

    Some examples of hormone therapy medications are:

    • Anti-androgens (flutamide, nilutamide)
    • LH-RH agonists (leuprolide, goserelin
    • Adrenal gland blockers (ketoconazole, aminoglutethimide)
    • Estrogens


  4. Watchful Waiting

    In certain men, a strategy of withholding active treatment may be used. While treatment is withheld, the patient is monitored closely for signs of change in their disease or the development of new symptoms. If it is determined at any time that the cancer is progressing, active treatment may then be started.

    This kind of “wait and see” approach is chosen most often in men who are older and who have other significant medical problems.


Less Common Treatment Options

Besides the four primary types of prostate cancer treatments, a number of additional, less-common options exist. Each of these options has its own set of benefits and drawbacks to consider.
  1. Cryotherapy

    This technique utilizes special equipment to freeze the prostate in order to kill cancer cells.

  2. Chemotherapy

    Chemotherapy is not commonly used to treat prostate cancer, but may be an option in certain men whose disease has spread outside of the prostate.

  3. HIFU

    HIFU stands for High Intensity Focused Ultrasound. It is a technology that utilizes ultrasound waves that have been focused onto a very small area to generate intense heat at that site. While not approved for use in the United States, HIFU is available elsewhere.

  4. Robot-Assisted Surgery

    Robotic instruments have been developed to assist surgeons in removing the prostate. This advance has been met with a great deal of excitement and discussion, but has its own shortcomings as well. Probably the most significant shortcoming that exists today with this option involves the steep learning curve that surgeons face when beginning to use one of these machines during surgery.

Sources:

Adolfsson J, Steineck G, Whitmore WF Jr Recent results of management of palpable clinically localized prostate cancer. Cancer 72 (2): 310-22, 1993.

Duncan W, Warde P, Catton CN, et al. Carcinoma of the prostate: results of radical radiotherapy (1970-1985) Int J Radiat Oncol Biol Phys 26 (2): 203-10, 1993.

Potosky AL, Legler J, Albertsen PC, et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst 92 (19): 1582-92, 2000.

Whitmore WF. Expectant management of clinically localized prostatic cancer. Semin Oncol 21 (5): 560-8, 1994.

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