Prostate Cancer

Watchful waiting and active surveillance are two forms of observation used to monitor early-stage cancers that appear to be growing slowly or cause no symptoms. These cancers may not need treatment until they progress.

Your doctor may also recommend observation if you’re older and have other medical conditions.

• Watchful waiting: With watchful waiting, you have regular appointments with your doctor to see if you develop symptoms or if any existing symptoms change. 
• Active surveillance: Active surveillance also involves regular visits with your doctor, except that you will also have regular physical exams and testing to monitor your cancer. When these tests show concerning results, you’ll begin medical treatment. 

Prostate cancer surgery can help men with early-stage cancers that haven’t spread to other parts of the body. It may be the only treatment you need, based on the stage of your cancer and your overall health. If cancer has spread outside your prostate, surgery isn’t as effective at treating cancer, but it may help reduce symptoms. 

Surgeons can perform a few procedures to treat prostate cancer: 

• Radical prostatectomy: This procedure involves removing the entire prostate gland, surrounding tissues and, potentially, nearby lymph nodes. Some prostatectomies can be performed with minimally invasive or robot-assisted techniques, which require smaller incisions. 
• Transurethral resection of the prostate (TURP): During this procedure, your surgeon removes some, but not all, of the prostate. TURP may be used to treat cancer that hasn’t spread, but it is generally used to reduce urinary symptoms caused by prostate cancer, not treat the cancer itself. 
• Orchiectomy: This is a surgery to remove your testicles. Less common than it used to be, orchiectomy is a form of hormone therapy because the goal is to reduce levels of male hormones that may cause prostate cancer to grow. 
• Holmium laser enucleation of the prostate (HoLEP): HoLEP is a minimally invasive procedure that uses lasers to remove prostate tissue causing symptoms. Your surgeon does not need to make any cuts to perform HoLEP.

Your doctor may suggest radiation therapy to treat prostate cancer if your cancer has started to spread or if you have a high Gleason score or PSA level. You may have radiation therapy along with other treatments. Radiation therapy can also be used to treat symptoms, such as bone pain, in advanced cancers. 

Three types may be used to treat prostate cancer: 

• External beam radiation therapy (EBRT): EBRT uses a source outside your body to aim high-energy rays at prostate cancer cells. Sometimes, imaging tests are used to help target a high dose of radiation as precisely as possible.
• Internal radiation therapy: Internal radiation, also called brachytherapy, is delivered through small seeds placed in the prostate.
• Radiopharmaceuticals: Radiopharmaceuticals are injected medications that deliver radiation to cancers through your bloodstream. Some radiopharmaceuticals are used for cancers that have spread to the bone, and others target cancers with specific proteins. 

In many cases, doctors use surgery, minimally invasive procedures and radiation therapy to treat early-stage cancers and cancers at low risk of growing or spreading. They may use systemic therapies to treat cancer cells that remain after those treatments or for cancers at high risk of growing or spreading. Often, systemic therapies are used to treat late-stage cancers that have spread to other parts of the body. 

• Hormone therapy: Hormone therapy, also called androgen deprivation therapy, can use medications (or surgery) to lower androgen levels or stop the body from producing androgens, which cause prostate cancer to grow. 
• Chemotherapy: Chemotherapy kills cancer cells throughout the body. In prostate cancer, they’re often used for cancers that may or have spread outside the prostate or for cancers that have returned. 
• Immunotherapy: Immunotherapy helps your immune system identify and kill cancer cells. The immunotherapies approved to treat prostate cancer are typically used only with advanced forms of the condition that haven’t responded to other treatments. 
• Targeted therapy: Targeted therapy targets proteins on prostate cancer cells with certain genetic mutations. This therapy is often combined with other treatments, such as chemo and hormone therapy, to treat advanced cancers.

Focal therapy is a newer treatment option that targets and destroys tumors within the prostate. Your healthcare provider may suggest this method if the cancer is low-risk and hasn't spread.

Focal therapy options may include: 

• High-intensity focused ultrasound (HIFU): This technique uses high-intensity sound waves to generate heat that kills cancer cells in the prostate. 
• Cryotherapy: This method uses cold gases to freeze and eliminate cancer cells in the prostate. 
• Laser ablation: Intense heat is directed at the tumor, effectively destroying the cancer cells. 
• Photodynamic therapy: In this approach, medications make cancer cells more sensitive to specific light wavelengths, which are then used to kill the cancer cells.