Prostate Cancer Treatments

Let's talk about prostate cancer treatments. There are several options available, and your healthcare team will help you figure out the best plan for you. They'll consider things like the size of your cancer, if it has spread, how fast it's growing, your overall health, and your personal preferences. Don't hesitate to discuss all your options with them.

Not every prostate cancer needs immediate treatment.

Sometimes, your healthcare team might suggest "active surveillance". This means they'll keep a close eye on the cancer with regular blood tests, imaging tests, and prostate biopsies. If the tests show the cancer is growing, then you can decide to start treatment. For some people, treatment might never even be necessary! Active surveillance can be a good choice if your prostate cancer isn't causing symptoms and is expected to grow very slowly. It might also be an option if you have other serious health issues that would make cancer treatment difficult.

One common treatment is surgery to remove the prostate, called a prostatectomy. This is often done when the cancer is only in the prostate, but sometimes it can also treat cancer that has grown larger or spread to the lymph nodes.

There are a few ways prostatectomy can be done:

• Laparoscopic prostatectomy: The surgeon makes several small cuts in your belly and uses special tools to remove the prostate.
• Robotic prostatectomy: This is the most common type of prostate cancer operation. The surgeon uses hand controls to guide robotic arms that hold the surgical tools. Like laparoscopic surgery, it involves several small cuts in the belly.
• Open prostatectomy: This is less common, but it might be the right choice in some cases. The surgeon makes one larger cut in the lower belly to remove the prostate.

As with any surgery, there are risks like bleeding, infection, pain, and blood clots, usually soon after the procedure. Laparoscopic and robotic prostatectomies tend to have a lower risk of these immediate side effects. Long-term side effects can include urinary incontinence (leaking urine) and erectile dysfunction (difficulty getting an erection), but these often improve over time.

Radiation therapy uses powerful energy beams to treat cancer.

External Beam Radiation Therapy: This involves a machine that aims radiation beams at your body. You lie on a table while the machine moves around you, directing energy beams (like X-rays or protons) to the prostate cancer. Typically, you'll have these treatments five days a week for several weeks, though some centers offer shorter schedules. External beam radiation is used for cancer that's only in the prostate, and for small cancers, it might be the only treatment needed. It can also be used after surgery to kill any remaining cancer cells and lower the risk of the cancer spreading or coming back. For advanced prostate cancer that has spread, such as to the bones, radiation can slow its growth and help with symptoms like pain.
Side effects can include bowel irritation, leading to diarrhea, bloody stool, or feeling like your bowel isn't completely empty. You might also experience frequent or painful urination, difficulty starting urination, and erectile dysfunction after treatment

Brachytherapy: This involves placing radioactive material directly inside your body.

• Permanent Brachytherapy (Low Dose Rate): This uses rice-sized radioactive seeds inserted into the prostate gland, which slowly release a low dose of radiation over time.
• Temporary Brachytherapy (High Dose Rate): Radioactive material is placed in the prostate for a short time and then removed. This treatment might be repeated over several days.
• Brachytherapy is used for prostate cancer that is contained only within the prostate and doesn't treat cancer that has spread. Side effects can include frequent or painful urination, blood in the urine, diarrhea, constipation, a feeling of incomplete bowel emptying, and difficulty getting an erection.

Ablation is a procedure that directly targets and damages cancer cells. It's not a standard prostate cancer treatment but is used in specific situations.

• Cryoablation (Cryotherapy): This uses cold to destroy cancer cells. Thin needles are inserted through the skin into the prostate, and a machine cools the needles to freeze the tissue around them. The freezing and thawing process harms the cancer cells.
• High-Intensity Focused Ultrasound (HIFU): This uses heat from high-intensity sound waves to damage cancer cells. A thin probe is inserted into the rectum, sending ultrasound waves to the prostate, heating the tissue to a temperature that hurts the cancer cells.

Ablation therapy is sometimes used for very small prostate cancers, especially when surgery isn't possible, such as if other health conditions make surgery or other treatments risky. It can also be used if the cancer returns, particularly after radiation therapy. Side effects can include pain and swelling in the treated area, and difficulty getting an erection. Sometimes, it can harm the bladder or the urethra, potentially requiring urinary catheters.

• Hormone Therapy: Prostate cancer cells need testosterone to grow, so hormone therapy aims to stop testosterone from being made or from reaching the cancer cells. This can cause cancer cells to die or grow more slowly.
  Hormone therapy options include:
  • Medicines that stop testosterone production: These medicines, like goserelin and degarelix, prevent the testicles from making testosterone.
  • Medicines that stop testosterone from acting on cancer cells (antiandrogens): These, such as bicalutamide and nilutamide, are often used with the medicines mentioned above.
  • Surgery to remove the testicles (orchiectomy): This quickly lowers testosterone levels in the body.
  • Hormone therapy is often used for prostate cancer that has spread to the lymph nodes or other parts of the body, as it can shrink the cancer and slow its growth. It can also be used with radiation therapy for cancer that hasn't spread beyond the prostate, making the radiation more effective. Side effects include hot flashes, trouble sleeping, loss of muscle, increased body fat, decreased sex drive, and difficulty with erections. There's also an increased risk of developing diabetes and heart disease.
• Chemotherapy: This uses strong medicines to treat cancer. Chemotherapy medicines, like docetaxel and cabazitaxel, are sometimes used with hormone therapy for advanced prostate cancer that has spread. It's also used when hormone therapy isn't working. These medicines are typically given through a vein every three weeks. Side effects can include extreme tiredness, easy bruising, more frequent infections, and nerve damage in the fingers and toes (peripheral neuropathy), causing numbness and tingling.
• Targeted Therapy: These medicines attack specific chemicals within cancer cells, causing them to die. For prostate cancer, targeted therapy can help treat cancer that has spread or returned after other treatments. They are often given with hormone therapy or sometimes alone. Examples include niraparib, olaparib, rucaparib, and talazoparib. These are usually taken as a pill or capsule. They work by blocking enzymes that help repair DNA breaks in cancer cells, but only if the cancer cells have certain DNA changes. Your healthcare team may test your blood or cancer cells to see if these changes are present. Side effects can include feeling very tired, nausea, loss of appetite, diarrhea, cough, easy bruising, and more frequent infections.
• Immunotherapy: This treatment uses medicine to help your body's immune system fight cancer cells. Normally, your immune system attacks foreign cells, but cancer cells can hide from it. Immunotherapy helps your immune system find and destroy them.
  
• Types of immunotherapy for prostate cancer include:
  • Cell therapy: This involves taking some of your immune cells, treating them in a lab to help them find prostate cancer cells, and then putting them back into your body to fight the cancer. One such treatment is sipuleucel-T, which can cause flu-like side effects such as fever, chills, and headache.
  • Immune checkpoint inhibitors: These medicines help immune cells find cancer cells by blocking signals that tell the immune system not to attack. These only work if the cancer cells have specific DNA changes, and most prostate cancers don't respond to them. Pembrolizumab is an example. Side effects can include extreme tiredness, itchy skin, diarrhea, loss of appetite, and rash. Sometimes, this treatment can cause the immune system to attack organs, leading to serious complications.
  • Immunotherapy is sometimes used for metastatic prostate cancer, which is cancer that has spread to other parts of the body.
• Radiopharmaceutical Treatments: These are medicines with a radioactive substance that deliver radiation directly to cancer cells. They are typically used for advanced prostate cancer, especially when it has spread (stage 4 metastatic prostate cancer).
• Examples include:
  • Treatments that target PSMA: Some radiopharmaceuticals target a protein called prostate-specific membrane antigen (PSMA) that is common on prostate cancer cells. Lutetium Lu-177 vipivotide tetraxetan is one such medicine. It finds and sticks to PSMA on cancer cells and releases radiation directly into them. This treatment can work on prostate cancer anywhere in the body, but only if the cancer cells make the PSMA protein. Side effects can include dry mouth, nausea, and feeling very tired.
  • Treatments that target the bones: Some radiopharmaceutical medicines contain a radioactive substance that is attracted to bones. When given through a vein, it travels to the bones and releases radiation. Radium Ra-223 is an example, sometimes used when prostate cancer has spread only to the bones. This can help with bone pain and other symptoms. Side effects include diarrhea and feeling very tired.