Treatments for advanced prostate cancer have come a long way and are getting better every day. That means you can expect fewer side effects and enjoy better results. The therapy your healthcare provider chooses may even put you in remission, which means tumor cells cannot be detected on imaging tests. Best of all, new treatments are being discovered all the time (including vaccines). Be sure to visit cancer.gov to stay on top of the most recent advances.
Many prostate cancers grow slowly, so when the cancer is detected early men can often be monitored for signs of progression—using periodic checkups, PSA tests and ultrasounds—and then treated later, if need be.
It might be right for you if: You have low-risk prostate cancer (small, symptom-free tumors) and a low Gleason score (6 or below).
What you should know: By opting for active surveillance, you may worry you’re missing an opportunity for early treatment. But according to the American Cancer Society, men who opt for surveillance and then take action when their cancer progresses, have as good an outcome as those who start treating low-risk tumors right away.
Beams of radiation are focused on the prostate gland from a machine outside the body. The treatments are painless and take only a few minutes each, but you may need up to five sessions per week over a period of seven to nine weeks to get the best benefit.
It might be right for you if: You are undergoing hormone therapy. Some doctors pair radiation with hormone therapy for better results.
What you should know: Fatigue, rectal burning and tenderness, and a frequent urge to urinate are common side effects, and they can last several months. You may also experience erectile difficulty.
In a radical prostatectomy, the entire prostate (plus some of the surrounding tissue) is removed. There are two basic ways to do this:
Open radical prostatectomy (ORP)
This surgery is done through a five- to eight-inch incision in the lower belly, or through a smaller incision in the perineum (the space between the anus and scrotum). It’s more difficult to collect lymph nodes and save the nerves that control erections with the perineal approach. But according to a study at the Albert Einstein College of Medicine in the Bronx, NY, this surgery tends to be faster, the recovery is speedier and it’s a good option for men with bigger bellies.
It might be right for you if: Your cancer hasn’t spread beyond your prostate—and in 90% of newly diagnosed cases, it hasn’t.
What you should know: You’ll spend a few days in the hospital, and will need to limit your activities for three to five weeks once you get home. The most concerning side effects are loss of bladder control (incontinence) and trouble getting an erection (impotence). Luckily, normal bladder control returns for many men within a few weeks or months—and the ability to get erections may gradually return, as well.
Robotic/laparoscopic radical prostatectomy (LRP)
This surgery is done through tiny incisions and uses narrow tools to remove the prostate (one has a tiny video camera on it). The tools can be held by a surgeon directly or moved using robotic arms that the surgeon controls.
It might be right for you if: Your cancer has not spread past your prostate (generally, men who are good candidates for ORP are also good candidates for LRP).
What you should know: Side effects may include incontinence and erectile dysfunction, which can last several months to indefinitely. According to a study at the Sidney Kimmel Center for Prostate and Urologic Cancers in New York City, opting for laparoscopic surgery could cut your hospital stay by 3%, since smaller incisions mean less tissue damage and a quicker recovery.
Chemotherapy drugs target and destroy cancer cells. Although they are usually injected into a vein, some can be taken in pill form. Once these drugs enter the bloodstream, they spread throughout the body and can destroy prostate cancer cells wherever they find them. Chemo is given in cycles, with each period of treatment followed by a period of rest so your body has time to recover. Each treatment-and-rest cycle typically lasts several weeks.
It might be right for you if: Your cancer has spread and hormone therapy has stopped working.
What you should know: In most cases, chemo is administered intravenously in a procedure known as an infusion. Sometimes chemo is taken as a pill, a liquid or by injection. It’s important to stay on the chemo schedule. If you skip a treatment, cancer cells could regrow. Also, strong chemo can reduce the number of infection-fighting white blood cells called neutrophils in your body, making you vulnerable to disease. Not only can infection interfere with your chemo schedule, it can also lead to life-threatening problems. Before you begin chemo, your healthcare provider will evaluate what steps you can take to boost your white blood cells. If necessary, he may prescribe a medication that increases levels of neutrophils.
Testosterone can fuel the growth of prostate cancers, so the goal of hormone therapy, also called androgen-deprivation therapy, is to either shut down your body’s testosterone production or stop your tissues from using this hormone. Some testosterone-suppressing medications are taken as pills or implanted under the skin, but many are injected (anywhere from once monthly to once yearly). According to the American Cancer Society, prostate cancers often become resistant to these treatments if they’re exposed nonstop—so some doctors now recommend intermittent hormone therapy, instead.
It might be right for you if: Your cancer has metastasized (spread).
What you should know: Hormone therapy has some significant side effects. It can cause hot flashes, loss of libido, loss of muscle mass and other symptoms. Long-term, it can raise your risk of bone thinning and heart disease. Report any symptoms to your doctor.