Prostate Cancer Health Center

The treatment that's right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects.

Active Surveillance

You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you're diagnosed with early stage prostate cancer that seems to be growing slowly. Your doctor may also offer this option if you are older or have other serious health problems.

Choosing active surveillance doesn't mean you're giving up. It means you're being careful and delaying treatment until such time as it seems absolutely necessary. Having surgery or radiation therapy can have serious side effects. They are no guarantee that a man will live longer than a man who chooses to put off treatment.

Surgery

Surgery is an option for men with early (Stage I or II) prostate cancer. It's sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

Before the surgeon removes the prostate, the lymph nodes in the pelvis may also be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:

• Open surgery. The surgeon makes a large incision to remove the tumor or the entire prostate. Removal of the prostate is called a prostatectomy. 
• Laparoscopic prostatectomy. The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube called a laparoscope helps the surgeon remove the prostate.
• Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot's arms.
• Cryosurgery. The surgeon uses a tool to freeze and kill prostate tissue. Cryosurgery is under study.
• TURP. A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

Radiation Therapy

Radiation therapy is an option for men with any stage of prostate cancer. Men with early stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

• External radiation. The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.
• Internal radiation. Sometimes called brachytherapy, the radiation comes from radioactive seeds that are implanted into the prostate. The seeds give off radiation for months to kill the cancer cells, and they don't need to be removed once the radiation is gone.

Hormone Therapy

A man with prostate cancer may have hormone therapy before, during or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment. It’s also most commonly used for prostate cancer that has spread.

Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body's main source of the male hormone testosterone. The adrenal gland makes other male hormones, as well as a small amount of testosterone.

Chemotherapy

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.

Chemotherapy uses drugs to kill cancer cells. The drugs for prostate cancer are usually given through a vein (intravenous). You may receive chemotherapy in a clinic, at the doctor's office, or at home. Some men need to stay in the hospital during treatment.