Treatment Options Vary Based On Several Factors
- Prostate cancer is incredibly common — and at the time of diagnosis, many men have disease that is considered “low-risk.” In these cases, doctors often recommend active surveillance, or closely monitoring the disease, instead of treating immediately.
- When treatment is recommended, but the disease is considered localized to the prostate, there are a range of potential treatment options including surgery and different types of radiation.
- “Usually, the two treatment options have been surgery, which now is done robotically, and radiation therapy,” Dr. Akshay Bhandari, the director of robotic surgery at Mount Sinai Medical Center in Miami Beach, tells SurvivorNet.
- When disease is too widespread for local treatment or returns despite it, doctors block testosterone, which helps cancer grow.
- Each treatment comes with its own side effect profile, and it’s important to discuss the risks vs. benefits with your doctor when making treatment choices.
The truth, often lost in that first bolt of fear, is that prostate cancer is usually treatable and frequently, even curable.
Read MoreDiagnosis & Determining Treatment
The first step towards a diagnosis might involves a PSA test — a simple and inexpensive blood test that measures the amount of prostate-specific antigen (PSA) in the blood. PSA is a protein produced in the prostate. A high number might indicate cancer, but can also come from infection, recent ejaculation, or an enlarged benign prostate.When screening for prostate cancer, doctors will also typically perform a digital rectal exam — a quick physical check that feels for hard or lumpy areas the PSA might miss.
If either test looks worrisome, your doctor may order a multiparametric MRI (mpMRI), a detailed scan that looks for suspicious spots, or a targeted biopsy.
After a biopsy, your doctor can send tissue to a pathologist for examination. If cancer is present, the pathologist will analyze it to determine its Gleason score. The Gleason score ranges from 6 to 10 — with a lower score indicating slower growing disease and a higher score indicating more aggressive disease.
That single number drives almost every treatment conversation that follows.
‘Active Surveillance’: It’s Not Just ‘Doing Nothing’
Once results are in, many men learn their cancer is low-risk, and the treatment choice may be to put off treatment. However, patients shouldn’t think of active surveillance as just “doing nothing.”
“We offer a lot of patients surveillance, where we don’t think they need to be treated. That is because they’re so early in their stage of disease that we feel they can be safely monitored for several years,” Dr. Bhandari explains.
This active surveillance strategy involves:
- PSA checks every 6-12 months
- Repeat MRI or biopsy only if numbers change
- Immediate treatment if, and only if, the cancer shows signs of waking up
Studies show men on surveillance live just as long as those who rush into treatment, but with far fewer side effects.
When Treatment Is Needed: Surgery & Radiation
When a patient has localized disease and their doctor thinks treatment is required, there are a range of potential treatment options including surgery and different types of radiation.
“Usually, the two treatment options have been surgery, which now is done robotically, and radiation therapy,” Dr. Bhandari explains.
With this new surgical technology, the entire prostate gland and often nearby lymph nodes, are removed in about 90 minutes through five or six keyhole cuts. Most men go home the next day.
After surgery, patients can expect:
- A small catheter left in for about one week
- Mild soreness, usually handled with over-the-counter pain pills
- Temporary urinary leakage (pelvic-floor “Kegel” exercises can help)
- Possible erectile problems while nerves heal
When it comes to surgery, age and health play big roles in recovery.
“The other major downside or impact from a quality of life standpoint after surgery is erectile dysfunction,” Dr. Bhandari explains. “The nerves that supply the penis that cause erections run very close to the prostate. So when we do the surgery, we try and spare those nerves, which we call the nerve sparing prostatectomy.”
However, even with nerve sparing efforts, some patients are left with long-term issues.
“Obviously if someone’s younger, someone’s healthier, doesn’t have diabetes, high blood pressure, heart disease… they will recover. The likelihood of them improving or recovering their erections is much higher then someone who’s in their later age, like 70s, or has diabetes … hypertension or coronary artery disease,” Dr. Bhandari adds.
Radiation Therapy
With radiation therapy, high-energy beams are used to treat prostate cancer without an incision. Classic courses run 4 to 8 weeks; although new “ultra-short” plans can finish in just five sessions.
Radiation therapy can be used after surgery, to get rid of any cancer cells that were left behind. Getting radiation along with surgery is called adjuvant therapy. This is sometimes used when the surgeon is unable to remove all of the cancer, tests after surgery show that the cancer is high risk, or the PSA is at detectable levels after surgery.
Side effects differ from surgery. These might include bowel irritation or later-on bleeding in the bladder or rectum.
Focal Therapies (HIFU, Cryotherapy)
“There are focal therapy like HIFU and cryotherapy that are options in a select population, but they do not have as robust or long-term survival data as surgery and radiation do,” Dr. Bhandari explains.
These techniques heat or freeze only the tumor zone.
They may suit men with a single, clearly defined lesion, but long-range data are still forming.
Options For Advanced Disease
After surgery or radiation, the PSA level should plummet to undetectable.
If it creeps up, doctors will watch you to determine what to do next. If the PSA level is going up slowly (over the course of a year), they may simply continue to observe. If it is rising quickly (less than six months after treatment), they may offer salvage radiation or hormone therapy.
Some men already have cancer that has spread to lymph nodes or bone at diagnosis. In that setting, the goal shifts from cure to control.
Hormone Therapy: Shutting Off the Fuel
When disease is too widespread for local treatment or returns despite it, doctors block testosterone, which helps cancer grow.
“When people go into a more advanced stage…that’s when we have the option of androgen deprivation therapy, which is essentially hormone therapy…taking away the testosterone to make the cancer a little bit more stable,” Dr. Bhandari explains.
While this treatment can be effective, it can cause side effects such as:
- Hot flashes, night sweats
- Fatigue and mild “brain fog”
- Weight gain around the belly
- Bone-thinning over time
Calcium, vitamin D, exercise, and heart-healthy eating can help soften these blows. Some men use intermittent therapy — months on, months off — to regain energy and intimacy during breaks.
Questions to Ask Your Doctor
- What is my risk level — low, intermediate, or high?
- Am I eligible for active surveillance?
- Which side effects are temporary? Which might linger?
- How often will you check my PSA?
- If my PSA rises, what’s next?
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