Prostate Cancer Treatments

Watchful waiting and active surveillance

Not all prostate cancers need immediate medical treatment. Your doctor may recommend watchful waiting or active surveillance if your cancer is not causing symptoms or hasn’t spread beyond the prostate. Both options are typically reserved for older men with slow-growing cancers and men who may have other medical issues.

These prostate cancer treatments allow your doctor to monitor your health and only begin treatment once the cancer begins to grow or spread.

• Watchful waiting: Your doctor will monitor your health and provide treatment if you develop symptoms, but you don’t receive treatment for cancer.
• Active surveillance: Your doctor will ask you to come back regularly for regular prostate exams and other tests. If the cancer grows, you will begin receiving medical treatment.

Prostate cancer surgery

Prostate cancer surgery aims to remove all or most of the cancer from your body. For men with early-stage cancers, surgery may be the only prostate cancer treatment necessary. Surgery may not effectively treat cancers that have spread outside the prostate, but it can help relieve symptoms.

Surgical oncologists perform a wide variety of prostate cancer surgeries. They use advanced techniques that minimize pain and shorten hospital stays. Your provider will direct you on how to prepare for the surgery and what to bring to the hospital on the day of your procedure.

Chemotherapy for prostate cancer

Chemotherapy is often used to treat prostate cancers that have spread or come back after initial treatment.

When used, chemotherapy is usually given intravenously (through an IV). The medication then travels throughout your body, attacking abnormal cells. After a prostate cancer treatment session with chemotherapy, you return home. You then return for another session a few weeks later.

Medical oncologists have access to many different chemotherapy medications. You may benefit from a single medication or a combination. Your team will explain the medications used and how many sessions you will need for prostate cancer treatment.

Hormone therapy for prostate cancer

Androgens, such as testosterone, are male hormones that encourage cancer cells to grow. Also known as androgen deprivation therapy (ADT), this treatment lowers the level of androgens in your body.

Although hormone therapy doesn’t cure prostate cancer, it helps slow its growth or shrink a tumor, allowing other treatments, such as radiation therapy, to be more effective.

You may benefit from ADT if your cancer returns after treatment. ADT is also an option if your cancer spreads so far beyond the prostate that surgery or radiation is not a good treatment option.

Hormone therapy options include:

• Medications to lower testosterone levels: LHRH agonists shrink testicles and reduce testosterone production. Administered via injection or implants every 1-6 months, they provide medical castration but may initially increase testosterone levels.
• Medications to lower or stop androgen production: Anti-androgens block androgens from promoting cancer growth. These daily oral medications connect to androgen receptors, preventing androgens from growing cancerous tumors. Multiple options are available for effective treatment.
• Orchiectomy: The goal of orchiectomy is the same as hormone therapy. This surgical procedure removes the testicles to reduce androgen levels, potentially slowing cancer growth or shrinking tumors. Artificial testicles can be used for a natural appearance.

Immunotherapy for prostate cancer

Most prostate cancer treatments use outside agents to attack or remove cancer cells. Immunotherapy uses your body to fight cancer. With immunotherapy, your immune system learns to recognize and attack cancerous cells that it otherwise overlooks. Currently, immunotherapy is used in very specific cases of advanced prostate cancer. Talk with your provider to learn more or determine if you’re a candidate for immunotherapy.

Immunotherapy options for prostate cancer may include:

• Cancer vaccine: For advanced prostate cancer without symptoms that no longer responds to hormone therapy, sipuleucel-T, an immunotherapy vaccine, may help extend life. White blood cells are collected, combined with a cancer-related protein in a lab, and reinfused every two weeks over three sessions.
• Immune checkpoint inhibitors: These treatments help the immune system recognize and attack cancer cells by disabling checkpoints that normally prevent this response. This therapy may be useful if genetic testing shows specific mutations in your prostate cancer cells.

Targeted therapy for prostate cancer

Targeted therapy is an approach to prostate cancer treatment that relies on a tumor’s genetics. Most cancer cells contain certain molecules that cause the cancer to spread. Targeted therapies identify those molecules and prevent them from functioning properly, which slows or stops cancer growth.

Targeted therapy may be used alone or with other therapies and typically causes fewer side effects than other treatment options. You may benefit from targeted therapy as metastatic prostate cancer treatment if your cancer spreads beyond your prostate.

Focal therapy for prostate cancer

Focal therapies may be beneficial if prostate cancer is confined to the prostate. With focal therapy, your provider can treat your whole prostate or a small area within the prostate where the cancer resides.

Focal therapy options for prostate cancer include:

• Cryotherapy: Intense cold is used to freeze and kill cancerous cells.
• High-intensity focused ultrasound: Heat is used to destroy cancerous cells.

Focal therapy is available if you have low- or intermediate-risk prostate cancer. However, your provider may first recommend other treatments, such as surgery or radiation. Additionally, you may undergo focal therapy as part of a plan that includes other treatments, such as radiation therapy.