Treatment options for prostate cancer

While prostate cancer is the second most common cancer in men in the United States, the incidence rate has been declining since the early 1990s.

Currently, there are seven types of treatment for prostate cancer that are considered standard, with more being studied in clinical trials.

Standard treatments for prostate cancer

Generally used for older men with prostate cancer who have no symptoms.
Treatment is withheld until symptoms appear.
Ongoing tests such as digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy monitor if the cancer is growing, at which point treatment is given to slow or cure the cancer.

For patients in good health whose tumor is localized in the prostate gland.
Can include any of the following types of surgical procedures:
- Radical prostatectomy: removes the prostate, surrounding tissue, and seminal vesicles. If there’s a reasonable chance the cancer may have spread to nearby lymph nodes, the surgeon may also remove these (known as a pelvic lymphadenectomy or pelvic lymph node dissection).
- Open prostatectomy: this can either be a retropubic prostatectomy where the surgeon makes an incision in the lower abdomen from the belly button to the pubic bone, or a perineal prostatectomy where the surgeon makes an incision between the scrotum and the anus.
- Laparoscopic prostatectomy: the surgeon makes several small incisions in the abdominal wall and uses special instruments with a video camera to see inside the body in order to remove the prostate.
- Robotic prostatectomy: a type of laparoscopic surgery in which the surgeon uses a robotic system to remove the prostate. The surgeon is present in the operating room and controls the robotic arms using a special control panel.
- Transurethral resection of the prostate (TURP): uses a resectoscope to remove tissue from the prostate, treat benign prostatic hypertrophy, relieve symptoms caused by the tumor, or treat men who cannot have a radical prostatectomy.
Depending on the size and location of the tumor, may include nerve-sparing surgery to save the nerves that control erection.

The type of radiation therapy depends on the type and stage of the cancer being treated.
Can be external radiation therapy (sent from a machine into the body directly at the cancer), internal radiation therapy (placing a radioactive substance sealed in needles, seeds, wires or catheters directly into or near the cancer) or radiopharmaceutical therapy (using a radioactive substance to treat cancer).
Radiation therapy for prostate cancer can increase the risk for bladder and/or gastrointestinal cancer.

Reduces the amount of male hormones or blocks them from working, thereby preventing the prostate cancer cells from growing.
Can include luteinizing hormone-releasing hormone agonists to stop the testicles from making testosterone, antiandrogens to block the actions of androgens, drugs that stop adrenal glands from making androgens, estrogens to prevent the testicles from making testosterone (rarely used because of risk of serious side effect), and orchiectomy (surgical removal of one or both testicles).

Stops the growth of cancer cells, either by killing the cells or by preventing them from growing.
Can be oral or injected into a vein or muscle (systemic chemotherapy) or placed directly into the cerebrospinal fluid, an organ or a body cavity such as the abdomen (regional chemotherapy).

Uses the patient’s immune system to boost, direct or restore the body’s natural defenses to fight cancer.
Can include Sipuleucel-T, technically a cancer vaccine that boosts the immune system to attack cancer cells.
Most effective in cases of metastatic prostate cancer.

Reduces bone disease when cancer has spread to the bone by preventing or slowing the growth of bone metastases.
Currently being studied in clinical trials.