Treatment Options for Prostate Cancer

Following a prostate cancer diagnosis, your doctor will perform a cancer risk assessment. This is to determine your chances of the cancer spreading beyond the prostate (metastasis) or the cancer returning after initial treatment (recurrence).¹

The assessment helps your doctor put you in a risk group. Risk groups help them understand how your cancer may behave over time and what treatment options it may respond to.¹

Some risk groups may need more invasive, curative treatment. Others may be diagnosed early on and undergo active surveillance. People diagnosed at advanced stages may undergo only palliative care. Palliative care is meant to relieve symptoms that affect quality of life, such as bone pain or bladder incontinence.¹

Below are some of the most common treatment options for prostate cancer.

Active surveillance and watchful waiting

Active surveillance and watchful waiting involve deciding to not treat prostate cancer that has not spread (localized prostate cancer) when it is diagnosed. They are options for low-risk prostate cancer. These approaches do not treat the cancer until the time is right.^1,2

Although they are not treating your cancer, your doctor monitors you closely and performs regular tests. Some doctors may use the terms "active surveillance" and "watchful waiting" to mean the same thing. But they are generally considered to be slightly different.^1,2

Active surveillance is more intensive follow-up care than watchful waiting. Active surveillance typically means trying to treat and cure the cancer if test results change. Watchful waiting typically means monitoring symptoms with the goal to treat symptoms if needed, but not to cure the disease.^1,2

Depending on your doctor’s explanation, the difference between the 2 terms may be minor or nonexistent. If your doctor recommends active surveillance or watchful waiting, ask them what that means for you and your treatment goals.^1,2

Surgery

Many cases of prostate cancer may benefit from surgery. But it is not always an option. Prostate cancer is harder to treat with surgery when the cancer is advanced or has spread (metastasized) to other parts of the body.^3-8

There are 3 main surgical procedures used for prostate cancer:^3-8

• Radical prostatectomy
• Transurethral resection of the prostate (TURP)
• Orchiectomy

Radical prostatectomy

When prostate cancer is found and treated before it has spread beyond the prostate gland, the cancer can be removed. But it requires removing the entire prostate gland as well. This is called a radical prostatectomy. It aims to cure prostate cancer.^4,5

Transurethral resection of the prostate (TURP)

TURP is not used as a curative treatment option for prostate cancer. Instead, it is used as a palliative care measure.⁶

When a prostate cancer tumor grows to the point that it pushes on the tube that carries urine from the bladder out of the body (the urethra), bladder or urinary problems may occur. Removing the part of the cancer or prostate that is pushing on the tube may relieve symptoms.⁶

Orchiectomy

An orchiectomy involves removing the testicles or the tissues that line the testicles. This surgery is a form of hormone therapy.^7,8

Radiation therapy

Radiation therapy for prostate cancer involves aiming high-energy particles or waves at cancer cells or tumors. It is used to cure a person’s prostate cancer or to relieve cancer-related symptoms.^1,9,10

Radiation therapy is generally used for prostate cancer in 2 ways:^1,9,10

• To cure, if the cancer is in the prostate gland only or has only advanced locally beyond the prostate gland
• To relieve symptoms that affect quality of life, such as bone pain when the cancer has metastasized to the bones

The 2 main types of radiation therapy for prostate cancer are external beam radiation therapy (EBRT) and internal radiation therapy (brachytherapy).^1,9,10

Cryotherapy

Cryotherapy is a nonsurgical treatment option that uses freezing cold temperatures to kill cancer cells. It is also called cryosurgery or cryoablation. Cryotherapy is less invasive than surgery and typically has a shorter recovery process.¹¹

In cryotherapy, very cold gas circulates through hollow probes that freeze the cells that the probes are touching, as well as others nearby. A whole-gland cryotherapy procedure will aim to destroy the entire prostate gland, including the cancer cells.¹¹

Hormone therapy

Hormone therapy aims to reduce the level of male hormones (androgens) in the body or prevent androgens from promoting cancer growth. Hormone therapy is also called androgen deprivation therapy (ADT).¹

Prostate cancer tumors are often fueled by androgens, specifically testosterone. Turning off the body’s ability to produce or respond to testosterone can potentially stop tumor growth.¹

Chemotherapy

Chemotherapy uses drugs that help prevent or stop the development or growth of tumors. Chemotherapy can be used at various points in the treatment process. It can be used to try to cure or control a cancer. It can also be a palliative care option.^1,12

Chemotherapy is systemic, meaning it affects the body as a whole. It is generally used when prostate cancer has spread to an area outside the prostate.^1,12

Immunotherapy

Cancer cells have the ability to evade the body’s natural immune response system. They do this by disguising themselves as normal, native cells. Immunotherapy helps train the natural immune response to find and attack cancer cells.¹³

Examples of cancer immunotherapies include:¹³

• Vaccines
• Cytokines
• Checkpoint inhibitors

There is currently 1 cancer vaccine on the market approved to treat prostate cancer. However, many other immunotherapy options, including additional vaccines, are being studied.¹³

Radiopharmaceuticals

Radiopharmaceuticals are part of a group of drugs that are considered systemic radiation therapies. These drugs contain radioactive substances. Some can help in the treatment of prostate cancer that has metastasized to the bones.^9,10

Some can also target the prostate-specific membrane antigen (PSMA) protein on prostate cancer cells to treat certain forms of metastatic prostate cancer. In some cases, certain radiopharmaceuticals may be used along with other treatment options, including EBRT.^9,10

Targeted therapy

Targeted cancer therapies stop or slow the spread of cancer by interfering with specific molecules that are involved in cancer growth (molecular targets) or by focusing on features that are unique to cancer cells. Targeted therapies are a type of precision medicine. This means that treatment is aimed at specific features of cancer cells, typically certain genetic mutations, to treat cancer.¹⁴

Targeted therapies are different from chemotherapy drugs. Chemotherapy attacks cells, both cancerous and healthy cells, in order to treat cancer. This often leads to unwanted and sometimes severe side effects. Because targeted therapy targets specific features of cancer cells, the goal is to do less damage to normal, healthy cells.¹⁴

Tissue-agnostic therapy

Tissue-agnostic therapy treats many forms of cancer that have a specific molecular change or biomarker that can be targeted by the treatment. This is different from other treatments that depend on the type of tissue or location of the cancer.¹⁵

Clinical trials known as basket trials study tissue-agnostic drugs. These clinical trials test how well a drug works for treating multiple types of cancer within the same trial. Several tissue-agnostic treatments have been approved by the US Food and Drug Administration (FDA). Others are being studied.¹⁵

Focal therapy

Focal therapy treats a small area of the prostate where the cancer cells reside, rather than treating the whole prostate gland. This is done using cryotherapy, laser ablation, or high-intensity focused ultrasound (HIFU). Focal therapy is typically for those with localized prostate cancer.^16,17

Focal therapy aims to treat the cancer and minimize side effects that can happen with other prostate cancer therapies. These side effects include bowel, urinary, or sexual problems. While it is a promising form of treatment, certain aspects of focal therapy are still being studied.¹⁶

Complementary and alternative treatments

When treating a condition, there are medicines and procedures that are considered standard medical care. This is also known as Western medicine.

Complementary and alternative medicine refers to treatments or therapies that are not part of Western medicine. Complementary medicine refers to treatments used in addition to standard medical care. Alternative medicine is used instead of standard medical care.^18,19

Complementary and alternative therapies can come in many forms, such as:^18,19

• Dietary and herbal supplements
• Lifestyle changes (diet and exercise)
• Massage therapy
• Acupuncture
• Hypnosis
• Cannabis
• Essential oils
• Mind-body therapies like yoga and tai chi

Speak with your doctor before starting any complementary or alternative treatments. They can make sure they are safe and appropriate for you.

Your prostate cancer treatment plan depends on many factors, including your risk group, personal medical history, and any concerns you have about treatment side effects. Your healthcare team will help determine the best course of action for your specific needs.