A number of different treatments are available to shrink or kill prostate cancer, including surgery, radiation therapy and chemotherapy. There are also new therapies under study. These include biological therapy, which works with the patient’s immune system to help fight or control side effects from other treatments, and high-intensity focused ultrasound, which directs high-energy sound waves at the cancer.
Many of these treatments cause side effects that affect quality of life, such as erectile dysfunction (problems getting or keeping an erection) and incontinence (loss of bladder control). Managing these symptoms is called palliative care, and it’s included along with treatment to slow or eliminate the cancer.
Prostate cancer is often diagnosed in an advanced stage, when the tumor has grown beyond the edge of the penis or into nearby lymph nodes. At this stage, most people choose not to have surgery or radiation therapy. Instead, their medical team may follow the patient for several months or more to see if the cancer is getting worse. This approach is called active surveillance.
If the prostate cancer grows or the PSA level rises, treatment will be started. The treatment chosen will depend on the patient’s risk. For low-risk patients, a less aggressive treatment is appropriate. These patients will likely benefit from an approach known as shared decision-making, where the doctor and patient discuss the pros and cons of treatment options.
The type of treatment that is best for each person depends on the stage and grade of the cancer, as well as how much the patient’s quality of life matters to him. A treatment plan should be tailored to each individual and include palliative care.
Treatments are more effective if given before the cancer spreads, which is why it’s important to talk to your doctor about screening and early detection.
A treatment that has shown promise is sipuleucel-T, which was approved by the FDA for use in 2017. It works by giving the body a boost of its own natural cancer-fighting immune cells. These cells are isolated from the patient’s blood in a process called leukapheresis, modified in a lab, and returned to the patient. The modified cells are designed to target and destroy prostate cancer cells.
Radiation therapy can cause many side effects, such as a burning sensation during urination; incontinence; and changes to erectile function. These side effects usually go away after treatment ends.
Another treatment option is brachytherapy, which involves placing radioactive seeds or pellets inside the prostate to destroy the cancer cells. This can be done as a single procedure while the patient is under anesthesia. The doctor can leave the seeds in place for a short time or permanently, and they can be left in for a higher or lower dose rate.
Other options include external beam radiation therapy, which uses x-rays to destroy the cancer; and proton beam radiation, which uses protons rather than x-rays, to deliver more precise treatment. These treatments are typically more expensive than other types of radiation therapy.
