There are many treatments for localized prostate cancer. The type of treatment your doctor suggests depends on many things. These may include your risk level, your age, and any other health problems. It is important to take time to learn about your cancer, your options for treatment, and possible side effects. Most men diagnosed with localized prostate cancer do not die from the disease.
Treatments for localized prostate cancer include:
- Watchful waiting
- Active surveillance
- Surgery to remove the prostate gland
- Radiation therapy
- Hormone therapy
Watchful Waiting
With watchful waiting, your doctor will watch you over time to see what happens with your cancer. If new symptoms start or old symptoms get worse, your doctor will help you manage them. Your doctor will not do any tests to see if your cancer is growing.
Active Surveillance
With active surveillance, your doctor will closely monitor you at regular checkups. During checkups, your doctor may do a digital rectal exam, a PSA blood test, a biopsy, or other tests to see if the cancer is growing. If tests show your cancer is starting to grow, your doctor will talk with you about other treatment options.
Surgery To Remove the Prostate Gland
In this type of surgery, the surgeon removes the prostate gland and seminal vesicles (the pair of glands attached to the prostate gland that help make semen). The prostate gland surrounds the upper part of the urethra (the tube that carries urine from the bladder). So, that part of the urethra must be removed as well. The remaining urethra is reattached to the bladder. The surgeon may also remove lymph nodes or other tissues around the prostate gland to check if the cancer has spread.
Before surgery to remove the prostate gland
After surgery to remove the prostate gland
Radiation Therapy
For this type of therapy, your doctor uses radiation to kill the prostate cancer cells.
Radiation can be given in two ways:
- External-beam radiation: This type of radiation treatment uses a machine to aim high-energy radiation beams at the cancer cells in your prostate gland. You lie on a table under the machine. The goal is to aim the beams only at the cancer cells and not to hurt the healthy tissues around the cancer. There are many different ways to give external-beam radiation. For example, the beams can be sent from different angles or at different strengths. Radiation treatment is given a few minutes a day, 5 days a week, for 8 to 9 weeks.
- Brachytherapy: This type of radiation is also called "radiation seeding." You will be given medicine so you do not feel pain. The doctor then uses an ultrasound probe to guide the needles that place small radioactive seeds (about the size of a grain of rice) into your prostate gland. The seeds slowly release radiation over time. Once the seeds stop releasing radiation, they stay in the prostate gland and do not need to be removed. This type of radiation is done in one visit, usually as an outpatient procedure.
Hormone Therapy
Prostate cancer cells need the male hormone testosterone to grow. Hormone therapy lowers the amount of testosterone in the body or blocks the effects of testosterone. This helps to slow or stop the cancer from growing. Hormone therapy comes as shots or pills.
- Hormone medicines that lower the amount of testosterone in the body include leuprolide (Lupron®, Viadur®, Eligard®) and goserelin (Zoladex®).
- Hormone medicines that block the effects of testosterone include flutamide (Eulexin®) and bicalutamide (Casodex®).
Hormone therapy is sometimes used together with radiation. It is also sometimes given before surgery to remove the prostate gland.
What have researchers found about how these treatments compare with each other?
Deciding which treatment may be best for you depends on many things, including your cancer risk level, what researchers have found about the treatments, and what is important to you regarding possible benefits and side effects of the treatments.
Researchers found that for some men:
- The risk of the cancer spreading to other parts of the body is much lower with surgery to remove the prostate gland than with watchful waiting.
- Surgery to remove the prostate gland appears to increase the chance of surviving the cancer more than external-beam radiation therapy.
- A combination of 3D-CRT (a type of external-beam radiation therapy) and hormone therapy appears to increase the chance of surviving the cancer more than 3D-CRT alone.
Note: In the time since this research was done, advances have been made in treatments for localized prostate cancer. Improved treatments and new treatments may now work better to treat localized prostate cancer.
Research is only one source that helps guide doctors when they treat localized prostate cancer. Doctors also rely on their experience and on guidelines for treatment based on evidence and recommendations by experts.
When thinking about what treatment may be best for you, your doctor will consider several things, including:
- Your age
- Your cancer risk level
- Your medical history
- Other health problems you may have
- How long you are expected to live
- Your preferences
Your doctor will also discuss possible side effects to help you decide about treatment. Talk with your doctor about your options and the trade-offs between possible benefits and side effects. Usually, you have time to think about your options before making a decision.
Note: In recent years (after much of the current research was done), more cases of localized prostate cancer are being found at very early stages using the PSA blood test. More research is needed to know which men whose prostate cancer is in a very early stage may benefit more from active surveillance than from other treatments. If your prostate cancer is in a very early stage, talk with your doctor about which treatment may be best for you.