Treatment
Treatment for prostate cancer often depends on the severity of your cancer, along with your age and general health. Here are some of the treatment options available for men with prostate cancer:
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Active surveillance
Prostate cancer usually grows slowly, so some men may only need to treat their cancer with “active surveillance.” Active surveillance entails monitoring the cancer with digital rectal exams and prostate-specific antigen tests every three to six months, and a transrectal ultrasound once a year. This may be a better option for older men and men in poor health who don't want to have a major operation or treatment side effects if they don't really need to. Some people prefer to have the cancer removed, no matter how slowly it grows.
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Radical prostatectomy
A radical prostatectomy is the most common surgery for prostate cancer. Your surgeon removes the entire prostate gland, seminal vesicles, and part of your urethra. Your surgeon may also take out surrounding lymph nodes and the neurovascular bundles that help control erectile function. Your surgeon then reattaches the bladder and the urethra to restore urinary function. Doctors may perform this surgery laparoscopically, with the assistance of a robot, or through surgical incision in your abdomen.
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Radiation Therapy
Radiation therapy uses waves of high-energy rays produced by a machine to kill cancer cells. Doctors often give radiation therapy to treat early-stage cancer that is still confined to the prostate. Men with early-stage prostate cancer often have a choice between surgery and radiation therapy to remove their cancer. In more advanced cases, doctors often combine radiation therapy with hormone therapy as the primary treatment for prostate cancer. There are two main types of radiation therapy. In external beam radiation, a large machine delivers radiation to your tumor from outside the body. One such treatment is IMRT which is used when the tumor is near the gastrointestinal tract. This type of radiation is controlled by changing the beam intensity, by using customized shielding to shape the beams, or both strategies. In internal radiation therapy, your doctor places radioactive pellets inside the body near the tumor (brachytherapy).
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Proton beam radiation therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. It delivers a radiation dose to the cancer, but is thought to limit damage from the radiation to surrounding tissues. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.
- Please see Understanding Proton Therapy for more information
Hormone Therapy
Prostate cancer is initially hormone-sensitive, meaning that male hormones such as testosterone cause the cancer to grow more aggressively. Hormone therapy blocks the production of testosterone and prevents it from fueling cell growth. Doctors often use hormone therapy to treat late-stage prostate cancer and about one of every three men with prostate cancer need this treatment.
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Cryotherapy
Doctors sometimes treat early-stage prostate cancer with cryotherapy. Your doctor inserts a long, thin probe into the tumor and shoots cold gases through the probe to freeze and destroy the tumor. The 2015 FDA approved HIFU (High-Intensity Focused Ultrasound). HIFU is a heat-based type of therapy. This technology uses ultrasound energy (sound waves), not radiation, to kill the cancer cells. An ultrasound probe is inserted into the rectum and the sound waves are directed at parts of the prostate gland with cancer. This treatment is designed to destroy cancer cells while limiting damage to the rest of the prostate gland. Candidates for HIFU are people who have early-stage, low-risk cancer that is only in their prostate.
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Chemotherapy
Chemotherapy is the use of drugs to treat rapidly growing cancer cells in an effort to destroy them. Chemotherapy medicationsare typically given through the vein (intravenously). The most common chemotherapy used in advanced prostate cancer is docetaxel (Taxotore).
Targeted Therapy
Some cancer cells contain too many proteins that cause the cancer cells to grow more aggressively. Targeted therapy specifically targets these cells, preventing the proteins from fueling cell growth. These drugs attack cancer cells while doing little damage to normal cells. Your doctor may recommend a PARP inhibitor. Olaparib and rucaparib are PARP inhibitors used when the prostate cancer has spread to other parts of the body and has mutations in the BRCA1, BRCA2, or other related genes.
Radiopharmaceuticals
Doctors can use targeted, injectable forms of radiation to treat advanced prostate cancer. Radium-223 (Xofigo) specifically targets bone metastases and is used in patients with advanced prostate cancer that has spread to the bone and has stopped responding to hormonal therapy. 177Lu-PSMA-617 (Pluvicto) delivers radiation to PSMA-expressing prostate cancer cells (which can be seen on a PSMA PET scan).
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Vaccine Therapy
Doctors can use a vaccines (sipuleucel-T) to treat advanced prostate cancer that has stopped responding to initial hormone therapy. The vaccine boosts your immune system's ability to fight prostate cancer cells. This treatment does not cure the disease, but may help men with advanced disease live longer. The vaccine is developed for each patient specifically by removing some white blood cells, exposing the cells to a protein from prostate cancer, and then re-injecting them back into the patients' bloodstream.
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Genetic Testing
Genetic testing can help to predict cancer prognosis, and is most helpful for patients with recently diagnosed prostate cancer or patients whose cancer has not spread from the prostate. Along with the prediction of prognosis, these tests make clear what therapies a physician should pursue in order to treat the cancer and may help with early detection in patients with a family history of prostate cancer or a gene that predisposes them to prostate cancer. Factors that suggest a genetic contribution to prostate cancer include multiple affected first-degree relatives with prostate cancer, early-onset prostate cancer, and prostate cancer with a family history of other cancers and may warrant the need for genetic testing. These tests may reveal which of the three risk categories- low-risk, middle/intermediate-risk, or high-risk- that a patient falls under. This knowledge allows for the doctor to determine the treatment options available to the patient.
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Several genes have been found to be associated with prostate cancer, including BRCA1 and BRCA2 genes. Among these, BRCA2 is one of the most common genes found in men with advanced prostate cancer. It has therefore emerged in clinical relevance in the treatment and screening of prostate cancer. The possibility of testing patients with prostate cancer and their relatives for BRCA2 mutations has been considered in order to lower the severity of existing prostate cancer.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
