There’s no single prostate cancer treatment option that’s right for every person, but there are plenty your doctor may consider. Before they recommend one for you, your doctor will consider many things, including:
- The size of your tumor and how far it has spread, known as the stage of your disease
- How quickly the tumor is likely to grow
- Your age and how healthy you are
- Your personal preferences
- Any other health conditions you might have
Watchful Waiting or Active Surveillance?
Your doctor might suggest waiting to see if your tumor will grow or spread before you treat it. Prostate cancer usually — but not always — grows slowly. Some doctors think it’s better not to treat it unless it changes or causes symptoms. There are two approaches to this:
Active surveillance
In this approach, you will have regular testing to find out if your cancer has started to grow at a faster pace. This would show your doctor that your disease has entered a more advanced phase and now needs treatment, such as surgery or radiation. You may have some or all of these tests:
Prostate-specific antigen (PSA) test. This test shows the amount of PSA in your blood. Higher levels of this protein are linked to prostate cancer. You’ll usually have this test about every six months.
Digital rectal exam (DRE). Your doctor will do DRE to feel for any lumps or other unusual changes in and around your prostate. This typically happens every year.
Imaging. AnMRI scan enables your doctor to get a closer look at what’s happening in your prostate.
Biopsy. In this procedure, your doctor takes tissue samples that can be examined to detect cancerous cells. You might have these every one to three years.
Your doctor will create a testing schedule based on the status of your cancer as well as your personal preferences.
Watchful waiting
Also called “observation,” this approach involves less follow-up and testing than active surveillance. Rather than focusing on cancer growth, your doctor will decide on a treatment plan based on any symptoms you have. Your doctor might recommend watchful waiting if you’re older or if you have other serious health conditions.
If you have a fast-growing cancer or your cancer has already spread beyond your prostate, your doctor will not recommend either of these approaches. Instead, you will be advised to start treatment.
Surgery
Surgery is an option if you’re healthy and your cancer hasn’t spread. The most common surgery for prostate cancer is called a radical prostatectomy. In this procedure, your surgeon removes your entire prostate gland and the surrounding tissues. They may also take out some lymph nodes in the area for testing to make sure your cancer hasn’t spread. If it has, your doctor won’t complete the surgery, because removing your prostate won’t help in the case of metastasis (spread of cancer cells).
The most common side effects from this operation are problems controlling your bladder (incontinence) and trouble getting and keeping an erection. Sometimes, they go away on their own after surgery, especially bladder control issues. Talk to your surgeon beforehand to see if they think they’ll be able to protect the nerves around your prostate to prevent these side effects.
Radiation
Radiation treatment for prostate cancer uses high-energy beams (similar to X-rays) to kill the cancer. It’s often a choice when your cancer is low-grade and hasn’t spread outside your prostate. You also might have it after surgery to get rid of any remaining cancer cells. It also helps with cancer that has spread to the bone.
There are two types of radiation:
- External: A machine outside your body directs rays at the cancer.
- Internal (brachytherapy): A doctor does surgery to place small radioactive “seeds” into or near the cancer.
Sometimes, a mix of both treatments works best.
Side effects of radiation can include problems with your bowel, such as diarrhea or blood in your poop. You might also need to pee more often, have a burning feeling when you pee, or see blood in your pee. Problems with controlling your bladder are also a risk after radiation treatment for prostate cancer.
Proton Beam Radiation
This noninvasive treatment uses radiation to destroy cancer cells. It does this in a very targeted way. This allows it to attack cancer cells without harming nearby tissue and organs. Most people with prostate cancer are candidates for this treatment, whether their cancer is in its early stages or has spread.
In some cases, your prostate cancer might not benefit from proton beam therapy. For example, if it’s an aggressive, fast-growing cancer that’s causing symptoms, you might need a treatment that works faster. Because proton beam therapy requires extensive planning, traditional radiation treatment may be a better option, as it can be started right away. Your doctor may not recommend this treatment if you have had a hip replacement, as the implants can interfere with it. Proton beam therapy can alsocause pacemakers to malfunction, so you may not be a candidate if you have a pacemaker.
Proton beam therapy may be the only treatment you’ll require. But it’s also used alongside other treatments, such as hormone therapy (androgen deprivation) and internal radiation (prostate brachytherapy). Your doctor may recommend it following other treatments, such as surgery.
Radiopharmaceuticals
These drugs contain radioactive materials that kill cancer cells that have spread beyond your prostate. In fact, this treatment can reach cancer wherever in your body it can be found. Other forms of radiation therapy do not have this capability. Your doctor may recommend radiopharmaceuticals if you have already been treated with hormone therapy and chemotherapy.
There are two types of radiopharmaceutical treatment. One only benefits you if your prostate cancer cells contain a protein called prostate-specific membrane antigen (PSMA). You will undergo a test called a PET scan to find out if your cancer contains this protein. The other treatment targets prostate cancer that has spread to your bones. These treatments can help ease bone pain and may help you live longer.
If you are a candidate for radiopharmaceuticals, you will receive this type of treatment via an injection or infusion into a vein. In a typical treatment schedule, you will receive up to six doses, each spaced six weeks apart.
Studies are currently underway to find out whether radiopharmaceuticals are effective when combined with other prostate cancer treatments, as well as whether they may help treat prostate cancer in earlier stages.
Photodynamic Therapy
If you have prostate cancer that’s localized just to your prostate, one possible treatment option is photodynamic therapy.
For this treatment option, you’ll take a light-sensitive drug called a photosensitizer either by taking a pill or getting an injection. After a certain amount of time passes, the cancer cells in your prostate will absorb the photosensitizer. Then, your doctor will insert thin, hollow needles into your prostate to aim light at it. Once the photosensitizer is exposed to a certain wavelength of light, the drug is activated and begins to kill cancer cells in that area.
Photodynamic therapy has many advantages, including that it can be done as an outpatient procedure, meaning you can go home afterward. Unlike other treatment options, it doesn’t use radiation and won’t cause side effects such as erectile dysfunction or incontinence.
Because photodynamic therapy is still being researched, this treatment option has some limitations, including how deep light can reach into a tumor. But your doctor may choose to use this therapy in combination with other treatments to fight your cancer.
Hormone Therapy
Prostate cancer cells need malesex hormones, such as testosterone, to keep growing. This treatment keeps the hormones from feeding the cancer cells. Your doctor might call it androgen deprivation therapy. Some hormone treatments lower your levels of testosterone and other male hormones. Other types block the way those hormones work. These drugs can slow or stop the growth of prostate cancers but only temporarily. They become less effective over time because cancer often develops a resistance to them.
Hormone therapy may be used in a few different circumstances:
- Along with radiation therapy in the early stages of cancer, before it has spread beyond your prostate. Hormone therapy may help prevent your cancer from returning after treatment.
- Before radiation therapy. Hormone therapy may shrink your tumor, which could make your radiation therapy more effective.
- If radiation or surgery does not cure your prostate cancer or if your prostate cancer returns after treatment.
- If your cancer has spread beyond your prostate and can no longer be treated by surgery or radiation.
- If you cannot undergo surgery or radiation for your prostate cancer.
There are several different ways that you can receive hormone therapy.
Orchiectomy. This surgery removes your testicles, where most male sex hormones are produced.
Luteinizing hormone-releasing hormone (LHRH) agonists and antagonists. These two similar types of drugs lower the amount of testosterone your testicles make. They are just as effective as orchiectomy for lowering testosterone. These drugs are given as injections, implants placed under your skin, or in pill form. Treatment timing varies. You may receive injections or implants every month or as infrequently as only once every six months. Pills are taken daily.
Drugs that stop hormone protection outside your testicles. Your adrenal gland cells and even your prostate cancer cells make hormones that can keep your prostate cancer growing. Certain drugs, taken daily as pills, can target the hormones made by these cells. They are used when your cancer stops responding to other types of hormone therapy. They also may be used in what’s called high-risk prostate cancer, which has spread to more than one place in your bones or to other organs.
Anti-androgens. These drugs stop hormones from feeding prostate cancer growth. Early versions of these drugs may be used alongside other types of hormone therapy. Newer types of anti-androgens may be used when:
- Your cancer has not spread beyond your prostate but no longer responds to other types of hormone therapy. This is called non-metastatic castration-resistant prostate cancer.
- Your cancer has spread beyond your prostate, but it still responds to other types of hormone therapy. This is called non-metastatic castration-sensitive prostate cancer.
- You have non-metastatic castration-sensitive prostate cancer that seems to have returned after treatment and will likely spread beyond your prostate.
- Your cancer has spread and no longer responds to other types of hormone therapy. This is called metastatic castration-resistant prostate cancer.
Chemotherapy
Most people with prostate cancer will not receive chemotherapy. But your doctor may recommend it if you have advanced prostate cancer that has spread widely beyond your prostate. You may receive chemo along with hormone therapy. If hormone therapy no longer works for you, you may undergo chemo on its own. Chemotherapy may shrink or slow your cancer, and it also may help improve your symptoms and make you feel better. It also may help you live longer. Unfortunately, chemotherapy likely won’t cure your cancer.
Most chemotherapy drugs are given via an IV infusion at your doctor’s office, a chemo clinic, or the hospital, though some come in pill form. You’ll receive your chemotherapy in cycles. This involves a period during which you get the medications followed by a recovery period. The schedule will depend on the drug you get. Most cycles last about three weeks. The number of cycles you will undergo depends on how effective your chemo is and the side effects that you experience.
Immunotherapy
This prostate cancer treatment helps your immune system target and destroy cancer cells. There are two common types.
Prostate cancer vaccine
Most vaccines work by boosting your body’s defenses to help it fight an infection. The prostate cancervaccine gets your immune system to attack cancer cells. Your doctor may recommend it if you have few or no prostate cancer symptoms and your cancer no longer responds to hormone therapy.
To create the vaccine, your doctor will take some of your white blood cells and mix them with a prostate cancer protein called prostatic acid phosphatase (PAP). You’ll receive this mixture as an infusion three times, with two weeks between treatments. This treatment has not been shown to cure cancer, but you may live several months longer.
Immune checkpoint inhibitors
Your immune system has built-in mechanisms to recognize healthy cells so that it does not attack them. These mechanisms are managed by proteins that serve as checkpoints, which send signals to tell your immune system to attack abnormal cells and to ignore healthy cells. Cancer cells can fool these checkpoint proteins so that they don’t tell your immune system to attack them. That’s not good. Fortunately, this class of drugs can help in some cases.
Two drugs currently available target a checkpoint protein called PD-1. This increases your immune system’s response to your cancer. But these drugs, which are given by infusion every three to six weeks, only work in a small number of prostate cancer cases.
Bisphosphonate Therapy
Bisphosphonates are drugs that treat prostate cancer that has spread to your bones. When that happens, bones in your cells called osteoclasts become more active. This causes pain and raises your risk of fractures.
Bisphosphonate drugs can calm overactive osteoclasts. This relieves pain and prevents bone fractures. They can alsostrengthen bones weakened during hormone therapy. You’ll receive these drugs by IV infusion every three to four weeks. You’ll need to take calcium and vitamin D supplements during this treatment so that your calcium level does not dip too low.
Cryotherapy or Cryosurgery
If you have early prostate cancer, your doctor might use cryotherapy to kill cancer cells by freezing them. They’ll put small needles or probes into your prostate to deliver very cold gasses that destroy the cells.
It’s hard to say for sure how well it works. Scientists haven’t done much long-term research that focuses on using it to treat prostate cancer. It’s usually not the first treatment a doctor recommends.
High-Intensity Focused Ultrasound (HIFU)
This minimally invasive therapy uses sound waves to precisely target and destroy cancer cells. Your doctor will use high-resolution pictures, biopsy results, and real-time ultrasound images to create a three-dimensional picture of your prostate cancer. That allows your doctor to limit the treatment only to cancerous cells, leaving healthy tissue, nerves, and blood vessels alone. That means less risk of damage that can cause incontinence or sexual problems. Once your doctor has identified trouble spots, a probe inserted into your rectum will emit sound waves that heat and kill cancer cells in those areas. You can go home shortly after the procedure.
HIFU treats early-stage, low-grade prostate cancer that has not spread beyond the prostate. Your doctor must be able to see your cancer using ultrasound imaging or MRI. It can treat single tumors or a part of a larger tumor.
PARP Inhibitor Therapy
This is a type of targeted cancer therapy, meaning it only attacks certain parts of a cancer cell. In this therapy, it blocks a protein called poly(ADP)-ribose polymerase (PARP), which normally helps repair damaged DNA within cells. Blocking PARP prevents certain types of cancer cells from repairing themselves. That causes them to die. But not everyone with prostate cancer will have the type of cells that respond to this treatment. Blood tests are one way to figure out whether you will benefit.
If you are a candidate for this treatment, you will take it once or twice daily as a pill or capsule along with hormone therapy.
Side Effects of Prostate Cancer Treatment
The treatments for prostate cancer can affect your body in other ways. Side effects of treatment will depend on the type of treatment (or treatments) you undergo. The most common side effects are urinary incontinence and erectile problems.
Other possible side effects include:
- Bowel problems (rare)
- Fatigue
- Fever
- Headaches
- Hot flashes
- Infertility
- Lowersex drive
- Mood changes
- Nausea, vomiting, and diarrhea
Before you begin treatment, talk to your doctor about the side effects you can expect and how those side effects can be managed. You can weigh these side effects against the potential benefits of treatment to help you decide how to proceed. For example, if your cancer was caught early, you may want to consider active surveillance to avoid the risks of surgery, such as incontinence or erectile problems. On the other hand, you may feel more comfortable having your cancer removed even if it’s not an immediate threat.
Your doctor can help you make these decisions. You also may want to consider getting a second opinion before you start treatment. Another option is joining support groups, where you can talk to others who have faced similar situations. This may help you as you weigh your options.
What Else Should You Consider?
Remember, you have options, and it’s important to choose the one that works best for you. When choosing a treatment, think about:
The risks. Talk to your doctor about the pros and cons of each type of therapy.
The side effects. Consider whether you’re willing to deal with how the treatment might make you feel.
Whether or not you need it. Not all men with prostate cancer need to be treated right away.
Your age and overall health. For older men or those with other serious health conditions, treatment may be less appealing than watchful waiting.
Takeaways
Many people with prostate cancer don’t require treatment. If you do, you have many options. Some of them can cure the disease. The right treatment for you will depend on several factors, such as the stage of your disease and the pace at which your cancer is growing. Your doctor will guide you through the benefits and risks of the treatments most appropriate for you.
Prostate Cancer Treatment FAQs
How many radiation treatments for prostate cancer are normal?
It depends on the type of radiation therapy. For example, external radiation therapy typically lasts at least several weeks, during which you’ll receive radiation five days a week.
What is the life expectancy of someone with prostate cancer?
The American Cancer Society estimates that 97% of those with prostate cancer will live at least five years after their diagnosis. But many people live much longer than that. You can be treated for prostate cancer and live a full life.
How serious is prostate cancer?
It depends. For some people, prostate cancer moves very slowly and will never become life-threatening. But this cancer can be quite aggressive and deadly.
At what stage is prostate cancer not curable?
Stage IV prostate cancer, in which cancer has spread elsewhere in the body, cannot be cured. But some treatments can slow it down and relieve symptoms.
What is the best treatment for prostate cancer in its early stages?
Both surgery and radiation are equally effective for curing early-stage prostate cancer.
Can prostate cancer be 100% cured?
Treatment for prostate cancer will look different for everyone. While there are no guarantees, early cases of prostate cancer can be treated with an almost 99% success rate.
What kills prostate cancer cells naturally?
There are no natural cures for prostate cancer, but during treatment, do your best to eat a well-balanced diet with lots of fruits, vegetables, and protein to make sure you’re getting the nutrients you need while you recover.
