The prostate cancer treatment that’s right for you depends on several factors including your age, the Gleason score, the cancer's stage, your symptoms, and your general health. Your prostate cancer doctor can describe your treatment choices, the expected results of each, and the possible side effects.
Because prostate cancer typically grows slowly, most men have time to review their treatment options and consider the pros and cons of a few different treatment paths. You and your oncologist can work together to develop a treatment plan that meets your medical and personal needs.
Although a common approach, prostate cancer removal surgery is not always a necessary part of treatment. Men with the earliest stages of prostate cancer may be recommended an active surveillance approach before beginning other treatments. Prostate cancer patients may receive one or a combination of the following treatments, including:
Active Surveillance
You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you’re diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.
Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.
If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months, at first). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. You’ll receive surgery, radiation therapy, or another approach.
Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.
If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option for most men.
Radiation Therapy for Prostate Cancer Treatment
Radiation therapy is an option for men with any stage of prostate cancer. Men with early stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.
Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:
External Beam Radiation
During these short treatment sessions you will lie down on a table and a linear accelerator machine will be directed to the exact spot where the cancer is located. The beams of radiation are then delivered from the linear accelerator.
Many men receive 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.
The length of time that each patient receives radiation therapy depends on several things including the stage of cancer. Traditionally this would be complete in 6-8 weeks. With a more advanced approach, called hypofractionated radiation therapy, the same dose of radiation can be given in each session, reducing the total number of weeks that treatments are needed. Hypofractionated radiation therapy usually lasts only 4-5 weeks.
The specific number of treatment sessions will depend on where the exact location of the cancer, its size, and the overall health condition.
Internal Radiation (Implant Radiation or Brachytherapy)
The radiation comes from radioactive material usually contained in very small implants called seeds. Dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. The seeds give off radiation for months. They don’t need to be removed once the radiation is gone.
Side Effects of Radiation Therapy
Both internal and external radiation can cause impotence. For most men, this improves after radiation therapy is complete. You can talk with your doctor about ways to help cope with this side effect. Other side effects can include fatigue and diarrhea. Talk with your prostate cancer specialist about ways to prepare for and manage the side effects of radiation therapy.
Affiliated Oncologists offers radiation therapy for prostate cancer treatment in the suburbs of South Chicago, so that it’s convenient for local residents to receive this type of cancer treatment.
Hormone Therapy
A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment.
Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body’s main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.
Hormone therapy uses drugs or surgery:
- Drugs: Your doctor may suggest a drug that can block natural hormones:
- Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Examples are leuprolide, goserelin, and triptorelin. The testosterone level falls slowly. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.
- Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
- Other drugs: Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.
- Surgery: Surgery to remove the testicles is called orchiectomy.
Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy. For some men, the cancer will be controlled for two or three years, but others will have a much shorter response to hormone therapy. In time, most prostate cancers can grow with very little or no male hormones, and hormone therapy alone is no longer helpful. At that time, your doctor may suggest chemotherapy or other forms of treatment that are under study. In many cases, the doctor may suggest continuing with hormone therapy because it may still be effective against some of the cancer cells.
Surgery to Remove Prostate Cancer
Surgery is an option for men with early (Stage I or II) prostate cancer. It’s sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.
Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.
There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:
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Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
- Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
- Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.
- Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.
- Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
- Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study. See the section on Taking Part in Cancer Research.
- TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.
Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.
If your prostate is removed, you will no longer produce semen. You’ll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.
Chemotherapy for Prostate Cancer
Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.
Clinical Trials for Prostate Cancer
A clinical trial is a research study meant to help improve current treatments or gather information on new treatments methods for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. The results of the clinical trials we participate in will advance the knowledge and treatments for patients everywhere. Consult with your cancer care team at Affiliated Oncologists to learn more about clinical trials for prostate cancer and if one is right for you.
Prostate Cancer Treatment Available in the South Chicago Area
If you have been recently diagnosed with prostate cancer, our cancer care team in the South Chicago suburbs can help you determine the best next steps for you. Our prostate cancer doctors offer the latest prostate cancer treatments available with personalized treatment plans tailored to you. Make an appointment at one of the Affiliated Oncologists locations in Chicago Ridge, Mokena, Hazel Crest, Palos Heights, New Lenox, Orland Park or Oak Lawn, IL to consult with our prostate cancer specialists.