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Prostate cancer treatment

Treatment for your prostate cancer is chosen after a thorough evaluation. Your health care provider will discuss the benefits and risks of each treatment.

Sometimes your provider may recommend one treatment for you because of your type of cancer and risk factors. Other times, there may be two or more treatments that could be good for you.

Factors you and your provider must think about include:

Ask your provider to explain these things following about your treatment choices:

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Radical Prostatectomy (Prostate Removal)

Radical prostatectomy is a surgery to remove the prostate and some of the surrounding tissue. It is an option when the cancer has not spread beyond the prostate gland.

Healthy men who will likely live 10 or more years after being diagnosed with prostate cancer often have this procedure.

Be aware that it is not always possible to know for certain, before surgery, if the cancer has spread beyond the prostate gland.

Possible problems after surgery include difficulty controlling urine and erection problems. Also, some men need further treatments after this surgery.

Radiation Therapy

Radiation therapy works best for treating prostate cancer that has not spread outside of the prostate. It may also be used after surgery if there is a risk that cancer cells are still present. Radiation is sometimes used for pain relief when cancer has spread to the bone.

External beam radiation therapy uses high-powered x-rays pointed at the prostate gland:

Side effects may include:

There are reports of secondary cancers arising from the radiation as well.

Proton therapy is another kind of radiation therapy used to treat prostate cancer. Proton beams target the tumor precisely, so there is less damage to the surrounding tissue. This therapy is not widely accepted or used.

Prostate Brachytherapy

Brachytherapy is often used for small prostate cancers that are found early and are slow-growing. Brachytherapy may be combined with external beam radiation therapy for more advanced cancers.

Brachytherapy involves placing radioactive seeds inside the prostate gland.

Side effects may include:

Hormonal Therapy

Testosterone is the main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is treatment that decreases the effect of testosterone on prostate cancer.

Hormone therapy is mainly used for cancer that has spread beyond the prostate, but it can also be used along with surgery and radiation to treat advanced cancers. The treatment can help relieve symptoms and prevent further growth and spread of cancer. But it does not cure the cancer.

The main type of hormone therapy is called a luteinizing hormone-releasing hormones (LH-RH) agonist. Another class of therapy is called LH-RH antagonists:

The other type of hormone medicine is called an androgen-blocking drug:

Much of the body's testosterone is made by the testes. As a result, surgery to remove the testes (called orchiectomy) can also be used as a hormonal treatment.

Chemotherapy

Chemotherapy and immunotherapy (medicine that helps the body's immune system fight the cancer) may be used to treat prostate cancer that no longer responds to hormone treatment. Usually a single drug or a combination of drugs is recommended.

Cryotherapy

Cryotherapy uses very cold temperatures to freeze and kill prostate cancer cells. The goal of cryosurgery is to destroy the entire prostate gland and possibly surrounding tissue.

Cryosurgery is generally not used as a first treatment for prostate cancer.

References

National Cancer Institute website. Prostate cancer treatment (PDQ) - health professional version. www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Updated September 3, 2021. Accessed December 8, 2021.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): prostate cancer. Version 2.2022. www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Updated November 30, 2021. Accessed December 8, 2021.

Nelson WG, Antonarakis ES, Carter HB, De Marzo AM, DeWeese TL. Prostate cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 81.

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Review Date: 10/3/2021  

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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