Treatment for prostate cancer is given by cancer specialists (oncologists). Some specialize in surgery, some in radiation therapy and others in chemotherapy (drugs). These doctors work with the person with cancer to decide on a treatment plan.
Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for prostate cancer are based on:
- type of prostate cancer
- 95% of prostate cancers are adenocarcinomas, which are generally slow growing tumours.
- prostate-specific antigen (PSA) level
- A rapid increase in PSA over a period of time may indicate progression of the cancer and require more aggressive treatment.
- stage and grade (Gleason score) of cancer
- A localized (within the prostate gland), low-risk, slow growing prostate cancer often requires no treatment. It may be closely monitored for evidence of any progression.
- A localized, intermediate-risk or high-risk prostate cancer is usually treated more aggressively with surgery or radiation therapy.
- Prostate cancer that has spread outside the prostate gland is treated primarily with hormonal therapy. Radiation therapy is sometimes given to metastatic sites in bone. Chemotherapy can be given when hormonal therapy has stopped working.
- The goal is to slow the progress and reduce the symptoms of the cancer (palliative therapy).
- Surgery may sometimes be used to relieve symptoms like urine blockage.
- age and general health of the man
- The age and health of a man with prostate cancer can influence the choice of treatment – radical prostatectomy in an elderly man in poor health involves a higher surgical risk compared to a middle-aged man in good health.
- Active surveillance may be an option for elderly men with coexisting illnesses.
- Treatment is often given to slow the growth of the cancer or relieve distressing symptoms like urinary obstruction or severe back pain.
- personal preference for treatment
- A man may want to think about the side effects of treatment such as incontinence or erectile dysfunction. Quality of life including, sexual function, is very important to some men.
Making decisions about treatment can be difficult. It is very useful for a man with prostate cancer to be well informed about the details of his diagnosis and treatment options. This allows an informed discussion with the doctors so a man can choose the treatment option that is best for him.
Treatment options for prostate cancer
- active surveillance
- Regular checkups are scheduled every 3 to 6 months.
- Checkups usually include a digital rectal examination (DRE), prostate-specific antigen (PSA) test and repeat prostate biopsies.
- radical prostatectomy – This is the most common surgery for removal of localized prostate cancer. It completely removes the prostate cancer.
- pelvic lymph node dissection – This is done at the time of radical prostatectomy to remove the lymph nodes in the pelvis. It is done for intermediate-risk and high-risk prostate cancer.
- transurethral resection of the prostate (TURP) – TURP relieves symptoms of urinary obstruction caused by an enlarged prostate pressing on the urethra. This surgery is used in men with advanced prostate cancer or men who are not healthy enough for radical prostatectomy. This surgery does not cure the cancer.
- radiation therapy
- The types of radiation therapy for prostate cancer are:
- external beam radiation
- brachytherapy (internal radiation therapy)
- Radiation therapy is usually combined with hormonal therapy in men who have high-risk prostate cancer.
- Hormonal therapy may be given for a period of time before and after the radiation therapy.
- hormonal therapy
- Hormonal therapy for prostate cancer may include:
- luteinizing hormone–releasing hormone (LHRH) agonists
- luteinizing hormone–releasing hormone (LHRH) antagonists
- anti-androgens (block effects of androgens in the tissue)
- removal of the testicles (orchiectomy)
- Hormonal therapy may be combined with radiation therapy in men who have high-risk prostate cancer.
- Hormonal therapy may be given for a period of time before and after radiation therapy.
- Hormonal therapy is sometimes given to men who have lymph node metastases found during radical prostatectomy. It is also given for prostate cancer that recurs after surgery or radiation.
- Chemotherapy is used in the treatment of castrate resistant prostate cancer (also called hormone-refractory prostate cancer.
- biological therapy
- follow-up after treatment is finished
- It is important to have regular follow-up visits, especially in the first 5 years after treatment.
Clinical trials investigate better ways to prevent, detect and treat cancer. There are some clinical trials in Canada that are open to men with prostate cancer. For more information, go to clinical trials.
See a list of questions to ask your doctor about treatment.