Treatment for Prostate Cancer

Treatment for prostate cancer can vary depending on various factors. Initial diagnosis and work-up of prostate cancer helps to indicate the grading and staging of the tumor. This information, as well as other factors such as your age and general health, helps physicians decide which treatment options are best for you and your specific cancer. While cancers that are caught early while they are still confined to the prostate gland can often have good results with local treatments such as surgical removal of the prostate, those with more invasive or widespread disease may require other treatment approaches such as radiation therapy and chemotherapy.

Prostate Surgery: Many men will have surgery as part of their treatment for prostate cancer. In particular, if the cancer appears to be confined to the prostate gland, without evidence for spread outside of the gland, then surgery is often the best option to control the disease. While the specific approach and technique used can vary (robotic prostatectomy versus traditional retropubic surgery, for example), the main goal is to completely remove the prostate gland and any tumor tissue contained within. Modern techniques attempt to avoid doing any damage to the muscles and nerves in the area that contribute to normal bowel and blader function and sexual function. In many cases, a local lymph node removal will be done at the same time to screen for any cancer which has spread to the local lymph nodes. The removed tissue is examined by a pathologist to indicate whether it appears that all the cancer tissue was removed or if any was left behind. If there is any evidence of cancer left behind or found in the lymph nodes, further treatments such as radiation or hormonal thearpy are often recommended.

Radiation Therapy: If some tumor tissue is left behind after surgery or if there is evidence of local recurrence after surgery, radiation therapy is often recommended to attempt to treat the remaining cancer cells in the area. Modern techniques generaly attempt to avoid exposure of surrounding normal tissues (such as the rectum and bladder) to the radiation.

Brachytherapy: This mode of treatment for prostate cancer uses implantable, radioactive "seeds" that release radiation into the tumor bed after surgery. It is one way to attempt to kill additional cancer cells which may be left behind after surgery.

Hormonal Therapy: Some prostate cancers respond to male sex hormones, such as testosterone, which make the tumor cells grown faster. Hormonal therapy is treatment for prostate cancer with medications which block the effect of these hormones, attempting to slow the growth of the remaining tumor cells. This type of therapy is generally not a cure but can help to slow the cancer grwoth and control it.

Cryotherapy: Freezing of the prostate gland is another treatment option for tumors confined to the gland. However, the long-term effectiveness of this treatment is not known yet and may not be as good as surgery or other treatments.

Conservative Management (Expectant Management): This is another option for treatment for prostate cancer. In many men, the diagnosis of prostate cancer occurs at an old age. They may also present first with a tumor which is small and appears to be slow growing. In these cases, putting the patient through surgery or other invasive treatments may do more harm than good. In these cases, it is sometimes a legitimate option to just wait and see, to follow the patient and not offer any treatment at this time. In fact, many men are believed to die "with prostate cancer" rather than "from prostate cancer". In other words, in these cases of older individuals or those with cancers which are not very aggressive, the cancer may never grow to a size or invasiveness that will cause any significant health problems during their lifetime. On the other end of the spectrum, an individual who first presents with very advanced and widespread disease may not benefit from treatment. Again, these decisions to treat or not are made based on many factors that are specific to each patient. Each patient should discuss the options and their prognosis with their own treating physicians.