There are a variety of treatment options available to treat prostate cancer. However, the treatment option depends on the level of progression of the cancer. A combination of treatments may also be used. Treatment options include surgery, radiotherapy, chemotherapy, hormone therapy, and clinical trials.

Overview of Treatment Options

Surgery

Radical Prostatectomy

A surgical procedure involving the removal of the prostate, surrounding tissues and seminal vesicles. This surgery is commonly used in early stages of prostate cancer before it has spread to other areas in the body. A radical prostatectomy offers the minimal collateral damage to surrounding tissues. A catheter is put into the bladder during the surgery to drain the urine and may be placed there for up to 3 weeks after surgery to ensure there is no blood in the urine. A radical prostatectomy can be performed through a few techniques; open surgery, laparoscopic or robotic. In an open surgery, the surgeon may make an incision in the lower abdomen or an incision between the scrotum and anus. A laparoscopic surgery involves a small incision and the use an instrumental tube with a camera. The robotic technique is fairly new, and involves the removal of the prostate through 2 or 3 robotic arms controlled by the surgeon. However, all techniques run a risk of erectile dysfunction. This occurs when the erectile nerves near the prostate are damaged during the operation. There are treatments available to help gain erectile capacity again. Patients are encouraged to discuss possible surgical techniques for a prostatectomy with their physician for the best course of treatment.

Transurethral Resection of the Prostate (TURP)

A surgical procedure used for men with advanced prostate cancer, or men who are not healthy enough for a radical prostatectomy. It involves the removal of part of the prostate through the urethra. A thin tube called a resectoscope is inserted through the penis into the urethra and removes prostate tissue.  A catheter is put into the bladder to drain the urine and may be placed there for up to 3 weeks after surgery to ensure there is no blood in the urine.

Pelvic lymph node dissection

A procedure completed as an open surgery or laparoscopic that removes the lymph nodes from the pelvis. It is completed if the cancer has spread to the lymph nodes. If there is cancer in the lymph nodes, the surgeon may not remove the prostate.

Post –Surgery

After your prostate cancer surgery, your body will take time to recover. It is very important to follow your physician’s post-surgery instructions to ensure you do not have any complications after surgery.

Exercise: For the following 6 weeks after surgery, heavy lifting of anything over 10lbs should be avoided. Exercises involving the core abdominal muscles or strenuous exercises should also be avoided. Taking short and slow walks would be beneficial over time to increase your strength again and return to your normal routine.

Nutrition: After surgery, it is important to eat healthy to increase your strength and benefit your overall health. At first, eating small meals frequently will be better for your stomach as large meals might not settle well. Avoiding or limiting fast food, fried foods, gravy, cheese and cream will help in recovery. Eating a low fat diet, fruits and vegetables will be beneficial post-surgery. If you are constipated, drinking more fluids and eating fibrous fruits will help. Your physician or dietician may recommend supplements for your post treatment regime.

Radiation Therapy

Radiation Therapy focuses external beams on the tumor to kill the cancerous cells. The beams do affect healthy cells as well, but the healthy cells are able to repair themselves after radiation while the cancerous cells cannot. There are two common radiation therapies used for prostate cancer; external beam and brachytherapy.

• External Beam: a machine outside the body directs the radiation to the tumor and surrounding tissue around it. It may be used as the first course of treatment or after surgery if the tumor has grown through the capsule of the prostate.
• Brachytherapy: An internal radiation therapy where tiny radioactive seeds are placed into the prostate gland and surrounding tissues around it. It is placed through tiny needles, and the seeds emit radiation for several weeks. The seeds will remain there permanently but do not cause any harm. It can be more advantageous than external beam as it is more focused on one area to avoid damage to other healthy tissues.

Chemotherapy

A cancer treatment using drugs to target and kill cancerous cells in the prostate and in the body. Chemotherapy may be given along with hormonal therapy, if hormonal therapy no longer works, and to relieve pain or control symptoms of advanced pain. Chemotherapy drugs currently used to treat prostate cancer are: docetaxel, mitoxantrone, cabazitaxel, estramustine, paclitaxel, doxorubicin, epirubicin, and vinorelbine.

Hormone Therapy

Hormones function as chemical signals in the body and are made by various glands. They are distributed to different parts of the body through the bloodstream. Androgens are male sex hormones produced by the testosterone. They are controlled by another hormone in the brain called LHRH. Androgens are needed for normal growth and function of the prostate gland. If androgens are removed or blocked, then it can block the progression of many cancer cells. The available treatments involve reducing androgen produced by testicles, blocking the action of androgens in the body, and blocking androgen production.

Orchiectomy

A surgical procedure used for hormone therapy where the testicles are removed to stop the production of male hormones. It is a minor procedure with a little pain and swelling for a week afterword.

LHRH agonist

Rather than having the testicles removed, a drug can block the production of androgens from the testicles.  A LHRH agonist is injected at regular intervals to control the prostate cancer growth. The common LHRH agonist used is degarelix.

Anti-androgen

A drug that can be used to block the effect of androgen without stopping the production of the hormone. It attaches to the prostate cancer cells and prevents them from growing. Anti-androgens are usually given with an orchiectomy or an LHRH agonist. Currently anti-androgen drugs include bicalutamide, flutamide, nilutamide, apalutamide, abiraterone acetate and enzalutamide.