Prostate Cancer

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Watchful Waiting

This involves your doctor monitoring the cancer to see if it is growing. Watchful waiting may be appropriate if you:

• Have early stage prostate cancer that is growing slowly
• Are of an advanced age
• Have serious health problems (risks of treatment outweigh the benefits)

Surgery

Types of surgery that may be needed include:

• Pelvic lymphadenectomy—removal of lymph nodes in the pelvis to determine if they contain cancer
• Radical retropubic prostatectomy—removal of the entire prostate and nearby lymph nodes through an incision in the abdomen
• Radical perineal prostatectomy—removal of the entire prostate through an incision between the scrotum and the anus
• Transurethral resection of the prostate (TURP)—removal of part of the prostate with an instrument inserted through the urethra (may be done to relieve symptoms)

Since prostate cancer surgery may cause side effects, like erectile dysfunction, urinary incontinence, and fecal incontinence, there may be other surgery techniques that may be a good option for you. Some examples include nerve-sparing surgery, robotic surgery, and laparoscopic surgery.

Radiation Therapy

Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. Examples include:

• Conformal radiation therapy—conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
• Intensity-modulated radiation therapy (IMRT)—IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.

Hormone Therapy

If prostate cancer has spread or has returned after being treated, hormone therapy may be used. The goal of hormone therapy is to lower the levels of male hormones, called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancer to shrink or slow its growth. Examples of hormone therapy include:

• Luteinizing hormone-releasing hormone (LHRH) analogs (such as goserelin, histrelin, leuprolide, triptorelin)—these drugs cause testosterone to drop to a very low level.
• Luteinizing hormone-releasing hormone (LHRH) antagonists (such as degarelix)—these also reduce the testosterone level, but do so faster and without the surge of testosterone that happens with the LHRH analogs.
• Anti-androgens (such as bicalutamide, flutamide, nilutamide)—these drugs work by interfering with the body's ability to use androgens.
• Other types of hormone therapy, such as:
  • Estrogen therapy—rarely used now unless other treatments are not working
  • Ketoconazole—affects the production of androgens
  • Abiraterone—may be used in cases where prostate cancer does not respond to other treatments
  • Orteronel (experimental drug)—affects the production of androgens
  • Enzalutamide—affects the production of androgens
  • Abiraterone—may be used in advanced stages of prostate cancer

In some case, a type of surgery called orchiectomy may be needed. This involves removing the testicles, which stops androgens from being produced.

Other Treatment Options

Other options may include:

• Cryosurgery—this involves using an instrument to freeze and destroy prostate cancer cells
• Chemotherapy—if prostate cancer has spread and other treatments have not been effective, chemotherapy may be used. There are range of chemotherapy drugs available, such as:
  • Docetaxel (this is usually the first chemotherapy drug that is tried)
  • Cabazitaxel
  • Mitoxantrone
  • Estramustine
  • Doxorubicin
• Immunotherapy—Immunotherapy is a drug treatment that aims to build your immune system so that you can better fight cancer cells. Sipuleucel-T is a type of immunotherapy that is approved to treat prostate cancer that has spread.
• Targeted therapies—Targeted therapies focus on the cancer cells, rather than attacking both the cancer cells and the healthy cells. Some examples include:
  • Selective endothelin A receptor antagonist (SERA)—interferes with the process that cancer cells go through to grow
  • Anti-angiogenic drugs—blocks the formation of new blood vessels, which stops the growth of the cancer cells
  • Tyrosine kinase inhibitors (such as Imatinib)—blocks the protein that triggers the cancer cells to multiply
• High-intensity focused ultrasound—This treatment involves using an endorectal probe (a probe that is inserted into the rectum) to destroy cancer cells with ultrasound energy.