Treatments for prostate cancer
If you have prostate cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for prostate cancer, your healthcare team will consider:
- the type and stage of the cancer
- the grade or Gleason score
- the possible side effects of treatments
- your personal preferences
- your overall health
- your age and life expectancy
Doctors may also classify prostate cancer based on the risk that it will come back (recur) after treatment. Men in the high-risk group are usually offered aggressive treatment. Those in the low-risk group may be offered active surveillance without immediate treatment. Find out more about the risk of prostate cancer recurrence.
You may be offered one or a combination of the following treatments for prostate cancer.
During active surveillance, the healthcare team watches for any signs and symptoms that mean the cancer is progressing. You will see your doctor and have tests every 3 to 6 months. You will begin treatment if there are signs that the disease is starting to grow or spread (called disease progression).
Depending on the stage of the cancer and your health status, you may have one of the following types of surgery.
Radical prostatectomy removes the prostate and some tissues around it, including the seminal vesicles. It is the type of surgery most commonly used to treat prostate cancer.
There are different types of radical prostatectomy including:
- retropubic radical prostatectomy
- perineal radical prostatectomy
- laparoscopic radical prostatectomy
- robotic radical prostatectomy
- nerve-sparing radical prostatectomy
Transurethral resection of the prostate (TURP)
A transurethral resection of the prostate (TURP) removes part of the prostate through the urethra. The goal of this surgery is to help relieve urinary problems caused by an enlarged prostate pressing on the urethra. It may also be done to reduce the size of the tumour before other treatments start. TURP is used to treat men with advanced prostate cancer or those who aren’t healthy enough to have a radical prostatectomy.
Cryosurgery uses extreme cold, such as liquid nitrogen or liquid carbon dioxide, to freeze and destroy abnormal cells. Right now, cryosurgery is an experimental treatment for prostate cancer. Sometimes doctors use it to treat prostate cancer that comes back after radiation therapy.
Pelvic lymph node dissection
A pelvic lymph node dissection (also called a PLND or pelvic lymphadenectomy) removes the lymph nodes in the pelvis. It may be done at the same time as a radical prostatectomy.
Radiation therapy is a common treatment for prostate cancer. Different approaches to radiation therapy can be used, including external beam radiation therapy, brachytherapy and systemic radiation therapy.
Hormonal therapy is most often used to treat advanced prostate cancer or prostate cancer that comes back after other treatments. It may be given during the same period of time as radiation therapy.
Chemotherapy may be used to treat advanced prostate cancer or prostate cancer that doesn’t respond to hormonal therapy or comes back after being treated with hormonal therapy (called castrate-resistant or hormone-refractory prostate cancer). Chemotherapy is also sometimes used along with hormonal therapy to treat men with metastatic prostate cancer.
High-intensity focused ultrasound (HIFU)
HIFU uses focused ultrasound waves to create intense heat, which destroys cancer cells. Right now, HIFU is an experimental treatment for prostate cancer. Sometimes doctors use it to treat prostate cancer that comes back after it is treated with radiation therapy.
Corticosteroids are steroid hormones that act as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances). Corticosteroids are sometimes given with chemotherapy to help chemotherapy work better and to lessen the side effects of chemotherapy. Corticosteroids may also be used alone if a person is too sick to have chemotherapy. They can help slow the growth of prostate cancer cells and relieve symptoms such as pain.
Prednisone and dexamethasone (Decadron, Dexasone) are the corticosteroids used most often to treat prostate cancer.
If you can’t have or don’t want cancer treatment
You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.
Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 5 years after treatment has finished. These visits allow your healthcare team to follow your progress and recovery from treatment.
Many clinical trials in Canada are open to men with prostate cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
After seeing a Canadian Cancer Society call for volunteers in a newspaper, Rosemary knew that this was her opportunity to get started.
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