Prostate Cancer Treatment Options

by Dr. Partha Mandal

It is important to determine if treatment is required. Low grade cancers usually grow slowly and do not require treatment especially if the patient is elderly and has other comorbidities which would limit life expectancy to less than or equal to 10 years.

Active Surveillance is important in low-risk cases, low grade cancers and limited size cancers. This includes having periodic PSA (Prostate Specific Antigen) testing and at least one additional biopsy 12 to 18 months after original diagnosis. In addition to serial PSA levels, MRI (Magnetic Resonance Imaging) can be used to follow patients.

Definitive treatment for localized disease includes radiation therapy (external beam and or brachytherapy radioactive seed placement), radical prostatectomy and cryotherapy. Radical Prostatectomy is the surgical removal of the prostate gland and seminal vesicles (glands which assist in semen production) and sometimes nearby lymph nodes.

Focal ablative therapy can include microwave, laser, high intensity focused ultrasound to treat a localized prostate cancer.

Testosterone is the primary male hormone. As high testosterone levels increase the risk for prostate cancer, the reduction of testosterone levels helps control its progression. Hormone therapy with medications to reduce the production of the precursors of formation of testosterone should be attempted first. Oral medications such as Bicalutamide or Cyproterone Acetate (anti-androgen) which helps reduce testosterone directly. Alternatively, an option for reduction of testosterone is a bilateral orchiectomy, a minor surgery to remove the contents of the testicles which is the main source of testosterone. Side effects of hormonal therapy include hot flashes, anxiety, palpitation, breast enlargement. However, these are treatable and manageable considering the reason for the treatment.

Surgical options include radical prostatectomy and lymph node dissection (removing affected lymph nodes and nearby lymph nodes to which the cancer may spread).

There may be complications of surgery including erectile dysfunction, urinary incontinence (inability to hold urine properly), urethral strictures (narrowing of the tube at any point from bladder to the penis), increased risk of groin hernias. These are treatable conditions.

Salvage Radiation Therapy after Radical Prostatectomy can be used if PSA levels have not normalized after operation.
Cryotherapy is the freezing of cancer cells and it can be used in cases where radiation has failed, as well as a primary form of treatment.

Chemotherapy may be used.

The goal is to keep PSA low, slow the progression of prostate cancer and to help prevent complications.

This article is published by the SVG Medical Association as part of its efforts to raise awareness about Prostate Cancer