What Are Treatment Options for Prostate Cancer?
Once you receive a prostate cancer diagnosis, your risk of a cancer-related event will be determined, such as your chance of metastasis (spreading beyond the prostate and throughout the body) or recurrence (the cancer returning after initial treatment). These risk groups are designed to develop an idea of how your cancer may behave over time and what treatment options it may respond to. Different risk groups may need more invasive, curative treatment immediately, while others may be diagnosed very early on and undergo active surveillance instead. Individuals who are diagnosed at very advanced stages may only undergo palliative treatment, or treatment that does not intend to cure, but rather, relieve quality of life-impacting symptoms 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 making the decision not to immediately treat localized prostate cancer, or prostate cancer that is slow growing upon diagnosis and is considered low-risk prostate cancer. This treatment approach involves not actually treating the cancer until the time is determined to do so. Although the cancer isn’t being treated, the patient will be closely followed, and regular tests will be performed. If your provider does not use these two terms interchangeably, it’s often understood that active surveillance is more intensive follow-up than watchful waiting, with active surveillance typically meaning eventually trying to treat and cure the cancer if there are differences in test results, while watchful waiting can sometimes mean monitoring patient symptoms with the eventual goal to treat patient symptoms as opposed to curing the disease. However, depending on your healthcare provider’s explanation, the difference between the two may be very minor or non-existent. If your healthcare provider is recommending active surveillance or watchful waiting, discuss with your provider what that means for your individual case and your goals of care for prostate cancer.1,2
Many cases of prostate cancer may find a benefit from surgical interventions. Prostate cancer may be inoperable when the cancer is advanced or has spread (metastasized) to other parts of the body. There are three main surgical procedures used for prostate cancer, including radical prostatectomy, transurethral resection of the prostate, and orchiectomy. When a case of prostate cancer is detected and treated before it has spread beyond the prostate gland, the cancer, as well as the entire prostate gland can be removed, thus, eradicating the cancer. This is called a radical prostatectomy, and it aims to cure prostate cancer.
Transurethral resection of the prostate, or TURP, is not used as a curative treatment option in prostate cancer, but is instead used as a palliative care measure. When a prostate cancer tumor grows to the point that it begins pushing on the urethra, the tube that carries the urine from the bladder and out of the body, bladder or urinary issues may occur. By removing the part of the cancer or prostate that is now pushing on the tube, some of these symptoms may be alleviated. Finally, an orchiectomy involves removing the testicles or the tissues that line the testicles. An orchiectomy serves as a type of treatment option in the form of hormone therapy.3-8
Radiation therapy for prostate cancer involves targeting high-energy particles or waves at cancer cells or tumors. This can be done with the intent to cure an individual’s prostate cancer, or can be used to relieve cancer-related symptoms. Typically, radiation therapy is used with the intention to cure in cases where an individual’s prostate cancer is in the prostate gland only, or has only advanced locally beyond the prostate gland. Radiation therapy utilized in advanced prostate cancer cases is generally intended to relieve quality of life-affecting symptoms such as bone pain when the cancer has metastasized to the bones. There are two main types of radiation therapy for prostate cancer, external beam radiation therapy (EBRT or EBT) and brachytherapy (internal radiation therapy).1,9,10
Cryotherapy, also called cryosurgery or cryoablation, is a non-surgical treatment option that uses freezing cold temperatures to kill cancer cells. Cryotherapy is less invasive than surgery and typically has a shorter recovery process. Freezing gas, typically argon gas, is circulated through the probes to 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, where focal cryotherapy, a newer technique, will aim to treat a small subsection of the prostate where the cancer cells reside.11,12
Androgen Deprivation Therapy (ADT), also known as hormone therapy, is defined as medications or procedures that are intended to lower the level of androgens in the body or prevent androgens from activating their target receptors (thus, making the androgens functionally useless). Prostate cancer tumors are often fueled to grow by androgens, specifically testosterone. Turning off the body’s ability to produce or respond to testosterone can potentially halt tumor growth.1
Chemotherapies indicated for cancer treatment are drugs that have antineoplastic properties, meaning that they act to prevent or halt the development or growth of tumors. Chemotherapies can be used at various points in the treatment process and can be utilized with the intention to cure or control a cancer, or as a palliative care option. Since chemotherapies are systemic, they are generally used when prostate cancer has spread to a location in the body outside of the prostate. Chemotherapies generally cause cancer cells to stop dividing and undergo apoptosis (cell death), thus, slowing or halting the growth of a cancerous mass.1,13
Cancer cells have the ability to evade the body’s natural immune response system under the disguise of being a normal, native cell. Immunotherapies as they relate to cancer, are treatments that aim to train the natural immune response into identifying and attacking cancerous cells. Examples of cancer immunotherapies include vaccines, cytokines, and checkpoint inhibitors. There is currently one cancer vaccine on the market indicated for prostate cancer, however, many other immunotherapy options, including additional vaccines, are being researched.14
Radiopharmaceuticals are part of a group of medications that are considered systemic radiation therapies. These medications contain radioactive substances that can help manage and alleviate bone pain when cancer metastasizes (or spreads) to the bones. In general, radiopharmaceuticals are typically used for prostate cancer that has metastasized to the bones. This treatment may be used in addition to other treatment options, including external beam radiation.
Targeted therapy is a new approach to prostate cancer treatment. Targeted cancer therapies stop or slow the spread of cancer by interfering with specific molecules ("molecular targets") that are involved in cancer growth. Moreover, targeted therapies are a type of precision medicine, in that, they aim at specific features of cancer cells, typically certain genetic mutations, to treat cancer.
Targeted therapies are different from chemotherapy drugs. Chemotherapy attacks cells, both cancerous and healthy cells, in order to treat cancer. This often leads those receiving chemotherapy to experience multiple and sometimes severe side effects. Targeted therapy targets specific features of cancer cells in order to combat the cancer. This means, in general, it does less damage to normal, healthy cells and causes fewer side effects.17
Tissue-agnostic therapy is a type of treatment that treats any kind of cancer as long as the cancer has a specific molecular change or biomarker that is targeted by the treatment. This is different from other treatments that depend on the type of tissue or location of the cancer. Tissue-agnostic drugs are studied in clinical trials known as “basket trials,” which are clinical trials that test how well a drug works for treating multiple types of cancer within the same trial.18 Several tissue-agnostic treatments have been approved by the FDA and others are currently being studied.
Complementary and alternative remedies
When treating a condition, there are often medications or procedures that are considered standard medical care. This can also be called mainstream care, Western medicine, or regular medicine, among other terms. For prostate cancer, standard medical care would include radiotherapy, chemotherapy, surgery, immunotherapy, and hormone therapy. In addition to standard medical care, there is also complementary and alternative medicine. Although these terms are sometimes used interchangeably, in general, complementary medicine refers to treatments used in addition to standard medical care, while alternative medicine is used instead of standard medical care.
Complementary and alternative therapies can come in many forms. These may include taking dietary supplements, making lifestyle changes (especially in regards to diet and exercise), and practicing therapies that improve the mind-body connection. Examples of complementary and alternative therapies include yoga, massage therapy, acupuncture, hypnosis, dietary changes or supplements, cannabis, essential oils, herbal supplements, and other home remedies.15,16 It is extremely important to speak with your healthcare providers before starting treatment with any sort of complementary or alternative methods to make sure they are safe and appropriate for you.
As mentioned previously, your treatment plan will be largely based on your risk group as well as your personal medical history and treatment side effect-related concerns. Your healthcare team will help determine the best course of action for your specific needs.