Overview of Prostate Cancer Treatment Options
Statistical Trends in Prostate Treatment
In the early 1990s, roughly 37 percent of prostate cancer patients in the United States were treated by radical prostatectomy, 32 percent by radiation therapy, 8 percent by hormone therapy, and 20 percent by no treatment (or "watchful waiting").1
Substantial changes have occurred in the treatment of prostate cancer from 1983 (prior to widespread use of PSA2) to 1995 (PSA widely used). The National Cancer Institute's SEER3 data demonstrate a substantial shift toward more aggressive therapy for clinically localized prostate cancer, most notably toward radical prostatectomy. The fractions having radiation therapy and hormone therapy have remained relatively stable. Since 1992, the proportion of cases having no treatment has risen while the proportions of cases undergoing radical prostatectomy or radiation therapy have fallen slightly. Since 1991, radical prostatectomy has been the most common treatment for prostate cancer.4
Making Treatment Decisions
If you have prostate cancer, you need to consider your age and general health before making a decision about treatment. You also need to think about which side effects you can live with. Some men, for example, cannot imagine living with side effects such as incontinence or impotence. Other men are less concerned about these and more concerned about survival.
Treatment decisions are often hard to make by yourself. No written information can take the place of talking directly with your health care professionals. In addition, talk with your family and friends and consider getting more than one opinion. It is natural for surgical specialists such as urologists to recommend surgery and for radiation oncologists to recommend radiation. Primary care doctors can help you choose the treatment that is best for you. You might find that speaking with others who have faced or are currently facing the same issues is useful. Organizations and support groups can help you learn more about what others in your situation are doing for their prostate cancer.5
Summary of Prostate Cancer Treatment Options
Brief summaries on the topics below are included on this page, with links at the end of each section that will take you to complete articles on the specific prostate cancer treatment topics.
- Observation - "Watchful Waiting"
- Hormonal Therapy
- Radiation Therapy
- Surgical Options
- Radical Prostatectomy
- Cryosurgery
- da Vinci Prostatectomy
- Information Resources
Observation — "Watchful Waiting"
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. This is usually used in older men with other medical problems and early-stage disease.6
Watchful waiting is based on the premise that cases of localized prostate cancers may advance so slowly that they are unlikely to cause men—especially older men—any problems during their lifetimes. Some men who opt for watchful waiting, also known as "observation" or "surveillance," have no active treatment unless symptoms appear. They are often asked to schedule regular medical checkups and to report any new symptoms to the doctor immediately.
» Continue to Watchful Waiting
Hormonal Therapy
Hormonal therapy combats prostate cancer by cutting off the supply of male hormones (androgens) such as testosterone that encourage prostate cancer growth. Hormonal control can be achieved by surgery to remove the testicles (the main source of testosterone) or by drugs.
Hormonal therapy targets cancer that has spread beyond the prostate gland and is thus beyond the reach of local treatments such as surgery or radiation therapy. Hormonal therapy is also helpful in alleviating the painful and distressing symptoms of advanced disease. Further, it is being investigated as a way to arrest cancer before it has a chance to metastasize. Although hormonal therapy cannot cure, it will usually shrink or halt the advance of disease, often for years.7
» Continue to Hormonal Therapy
Radiation Therapy
Radiation therapy uses high-energy x-rays, either beamed from a machine or emitted by radioactive seeds implanted in the prostate, to kill cancer cells. When prostate cancer is localized, radiation therapy serves as an alternative to surgery. External beam radiation therapy is also commonly used to treat men with regional disease, whose cancers have spread too widely in the pelvis to be removed surgically, but who have no evidence of spreading to the lymph nodes. In men with advanced disease, radiation therapy can help to shrink tumors and relieve pain.8
Surgical Options
Radical Prostatectomy
An operation called radical prostatectomy completely removes the prostate and nearby tissues. A radical prostatectomy is further described in terms of the incisions used by the surgeon to reach the gland. In a retropubic prostatectomy, the prostate is reached through an incision in the lower abdomen; in a perineal prostatectomy, the approach is through the perineum, the space between the scrotum and the anus.
Cryosurgery
Cryosurgery uses liquid nitrogen to freeze and kill prostate cancer cells. Guided by TRUS, the doctor places needles in preselected locations in the prostate gland. The needle tracks are dilated for the thin metal cryo probes to be inserted through the skin of the perineum into the prostate. Liquid nitrogen in the cryo probes forms an ice ball that freezes the prostate cancer cells; as the cells thaw, they rupture. The procedure takes about 2 hours, requires anesthesia (either general or spinal), and requires 1 or 2 days in the hospital.9
da Vinci® Prostatectomy
You may also be a candidate for a new, less invasive approach to prostate removal called the da Vinci® Prostatectomy. This method incorporates the latest advancements in robotic-assisted technology and allows a surgeon greater visualization, enhanced dexterity, precision, control and superior ergonomics.
» Continue to Surgical Options
Clinical Trials
New types of treatment are being tested in clinical trials. These include the following:
Biologic therapy
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.8
High-intensity Focused Ultrasound
High-intensity focused ultrasound is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves.9
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Additional Prostate Cancer Treatment Information
No written information can take the place of talking directly with your health care professionals. As part of prostate cancer treatment and ongoing health, it is important to work closely with your doctor to inform yourself of your options. In the initial phases of consultation and discovery, there are key questions that can be directed to your physician. In addition, issues such as pain management and follow-up care should be addressed. Additional resources to help you understand prostate cancer can be found on the Internet.