In this guide we explore what are the different prostate cancer treatment options and identify the benefits and the potential risks of each option.
Prostate cancer is linked to cells growing abnormally in the prostate gland, which is located below the bladder and is responsible for making some of the fluid found in men’s semen. The majority of cases are adenocarcinomas – meaning that they originate in glandular tissue – but there are different types of prostate cancer including sarcomas, small cell carcinomas, and others, so it is important to understand what are the different prostate cancer treatment options. Common symptoms can include blood in the urine or semen, erectile dysfunction, difficulty urinating, weakness or reduced sensation in the legs and feet, and unexplained pain in the hips, spine and other areas.
Following skin cancer, cancer of the prostate is the most common type of cancer in American men. Around 1 in 7 males will be diagnosed with the disease in their lifetime, more commonly after the age of 65. However, while serious if not caught early, many patients do make a full recovery: there are now over 2 million prostate cancer survivors in the US!
If caught early, the chances of surviving prostate cancer are high – largely because there are many treatment routes a patient can try. Depending on the stage, you will need to discuss what are the different prostate cancer treatment options with your doctor. Each type of prostate cancer treatment holds various benefits and potential risks or side effects, so it’s important to weigh these carefully before making a decision.
Due to the slow-growing nature of prostate cancer, depending on age and other health factors some men may never require treatment for prostate cancer. Active surveillance is a method wherein your healthcare practitioner closely monitors the cancer’s growth. This usually involves a digital rectal exam and a prostate-specific antigen blood test every six months. On top of this, a cell biopsy may also be taken from your prostate each year to take a closer look at any changes. Should any of these tests show a noticeable change, you would then consider looking at what are the different prostate cancer treatment options to tackle the cancerous cells. Active surveillance is usually suitable if the disease is small and isn’t expected to grow quickly (according to a Gleason score), is localized to the prostate, and isn’t showing any symptoms which affect your quality of life.
If the cancer has not spread to other parts of the body, prostate cancer surgery is a common method to try and tackle the disease, and will probably be mentioned by your doctor when they are discussing what are the different prostate cancer treatment options available to you. Radical prostatectomy is the main types of surgery, with the surgeon aiming to remove the prostate gland in its entirety, along with surrounding tissue and the seminal vesicles. From open approaches to laparoscopic approaches, there are different ways that this surgery can be performed. Each carries its own benefits and drawbacks, with radical prostatectomy being regarded as major surgery and thereby carrying slightly higher risk factors. In general, side effects of any prostate cancer surgery include erectile dysfunction and urinary incontinence, but these can be temporary and there are further treatment options to help counter impotence should it occur.
Now that you know what are the different prostate cancer treatment options involving surgery, we explain the radiation therapy options. If the prostate cancer remains localized to the prostate gland and isn’t high grade, radiation therapy is often the first prostate cancer treatment used. It is usually as effective at curing the disease as undergoing a radical prostatectomy, with the two main types of radiation therapy being external beam radiation (EBRT) and brachytherapy (i.e. internal radiation).
External beam radiation therapy involves focusing the beams onto the prostate gland through laser technology. Newer techniques focus on the tumor directly, preventing damage to surrounding cells unnecessarily. The possible side effects of EBRT include potential bowel and urinary problems, known as radiation proctitis and radiation cystitis. Erectile problems can also occur, but these are slower developing than the damage which can occur during surgery: usually problems with impotence occur gradually over a period of years following the radiation therapy.
Brachytherapy involves inserting rice grain-sized radioactive pellets into the prostate. It is not suitable for men with a large prostate, and it is often used as a standalone treatment for prostate cancer, when it is in the early-stage. A permanent brachytherapy involves low dose pellets being inserted and then left in the prostate, where they emit radiation over weeks or months. Once all of the radioactive material is used up, the pellets are totally harmless. Alternatively, temporary brachytherapy – which is less common – involves exposing the prostate to higher doses of radiation for a shorter time. This method involves the use of catheters and needles through which the cells receive exposure to radioactive material. Usually, the patient receives three short treatments over a two day period, after which the catheters are removed. Potential side effects of brachytherapy are similar to those of external beam radiation therapy, though these are often more localized and tend to be short term issues.
With the use of exceptionally cold temperatures, cryotherapy aims to freeze and thereby kill prostate cancer cells. This method is generally used to treat early stages of the cancer, particularly if it reoccurs after radiation therapy. The procedure involves passing a hollow needle through the skin between the scrotum and anus, whereby cold gas passes through the needles to freeze the cancerous cells. As one of the less invasive prostate cancer treatment options, cryotherapy offers a shorter recovery time and less pain. However, it doesn’t seem to be as effective at curing more advanced tumors, so if you are already at an advanced stage you will need to look at what are the different prostate cancer treatment options for cancer that has advanced or metasised.
Side effects tend to be heightened if the patient has already undergone radiation therapy, but most men will experience soreness and swelling in their penis and scrotum following the procedure. The freezing process can also temporarily damage the rectum and bladder, but normal functioning usually returns over time as these heal. However, the freezing temperatures often damage surrounding nerves, including those which control erections. As such, erectile dysfunction is a common side effect of cryotherapy – more common than in those men who opt for radiation therapy.
Often referred to as androgen deprivation therapy, hormone therapy is a prostate cancer treatment which aims to reduce the level of androgens (i.e. male hormones) in the body. Alternatively, it can aim to prevent androgens from affecting the cancerous cells. The reason behind this is that androgens act as a stimulant for the cancer cells, encouraging them to grow and thereby progressing the stage of cancer. It is important to note that, whilst reducing androgen levels of prohibiting them from reaching the prostate can shrink the tumor or slow down the growth temporarily, it is not a cure in itself. Instead, this therapy is used alongside other treatments – to enhance their effects. Likewise, it can be used to slow the cancer if the disease has already spread and become metastatic prostate cancer and is therefore too advanced to be cured by radiation or surgery options.
Whether you and your doctor opt for an orchiectomy, LHRH agonist or antagonist hormone therapy, all methods can cause similar side effects. These are all linked to the overall effect of diminished levels of testosterone and other male hormones in the body, and range from a loss of sexual desire, impotence and shrinkage of the penis and testicles, to osteoporosis, weight gain, and depression. There are alternative types of hormone therapies that you can try aside from those mentioned, so make sure you ask your doctor what are the different prostate cancer treatment options to ensure you explore all possibilities.
Using anti-cancer drugs which are taken orally or injected into a vein, chemotherapy – commonly referred to as “chemo” – aims to attack the disease using the patient’s bloodstream to access the cancerous cells. This option is particularly useful if the cancer has spread further than the prostate gland, and recent research suggests that combining this treatment with hormone therapy is especially effective.
Chemotherapy is regarded as a somewhat aggressive treatment option: the drugs attack cells which divide quickly, hence why they are drawn to cancerous cells. However, this means they also attack non-cancerous cells which also divide rapidly, including those which line the mouth and intestines, and hair follicles too. As a result, side effects relate to these body parts. Hair loss is very common, whilst the likes of mouth sores, vomiting, diarrhea, a reduced appetite, and a damaged immune system are all potential side effects of chemotherapy. Fortunately, though, these usually cease after treatment ends, and patients can take medication to help ease side effects during their chemotherapy.
As a cancer vaccine, Sipuleucel-T (Provenge) serves to boost your immune system, which in turn helps you to attack cancerous cells in the prostate glands more effectively. This vaccine is only as a treatment option when the cancer has progressed to an advanced stage, known as metastatic prostate cancer, and when the cancerous cells have stopped responding to hormone therapy. Likewise, it is only usually suitable if the metastatic prostate cancer is still causing minimal symptoms.
Tailor-made for each man, the cancer vaccine requires white blood cells from the patient. These are then exposed to prostate cancer cells in the lab, where the white blood cells have chance to attack them. Following this, the white blood cells are then returned into the patient through an intravenous drip; the process is repeated twice more over a period of four weeks. Whilst this treatment for prostate cancer hasn’t been shown to prevent further growth of the cancer cells, it does correlate with a longer life expectancy in those suffering from advanced prostate cancer. So, whilst it doesn’t cure the disease, it can help you to live several months longer should your cancer progress to a terminal stage.
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