Watchful Waiting

This involves your doctor monitoring the cancer to see if it is growing. Watchful waiting may be appropriate if you:

• Have early stage prostate cancer that is growing slowly
• Are of an advanced age
• Have serious health problems where the risks of treatment outweigh the benefits

Surgery

Types of surgery that may be needed include:

• Pelvic lymphadenectomy—removal of lymph nodes in the pelvis to determine if they contain cancer
• Radical retropubic prostatectomy —removal of the entire prostate and nearby lymph nodes through an incision in the abdomen
• Radical perineal prostatectomy —removal of the entire prostate through an incision between the scrotum and the anus
• Transurethral resection of the prostate (TURP)—removal of part of the prostate with an instrument inserted through the urethra (may be done to relieve symptoms)

Since prostate cancer surgery may cause side effects, like erectile dysfunction, urinary incontinence, and fecal incontinence, there may be other surgery techniques that may be a good option for you. Some examples include nerve-sparing surgery, robotic surgery, and laparoscopic surgery.

Radiation Therapy

Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. Examples include:

• Conformal radiation therapy—Conformal radiation therapy uses 3-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
• Intensity-modulated radiation therapy (IMRT)—IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.

Hormone Therapy

If prostate cancer has spread or has returned after being treated, hormone therapy may be used. The goal of hormone therapy is to lower the levels of male hormones called androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancer to shrink or slow its growth.

Hormone therapy may include:

• Luteinizing hormone-releasing hormone (LHRH) analogs
• Luteinizing hormone-releasing hormone (LHRH) antagonists
• Anti-androgens
• Estrogen therapy—rarely used now unless other treatments are not working
• Antifungal medications
• Antineoplastic agents

In some case, a type of surgery called orchiectomy may be needed. This involves removing the testicles, which stops androgens from being produced.

Other Treatment Options

Other options may include:

• Cryosurgery—this involves using an instrument to freeze and destroy prostate cancer cells
• Chemotherapy —mainly used to relieve symptoms of metastatic cancer
• Immunotherapy—a drug treatment that builds your immune system so that you can better fight cancer cells
• Targeted therapies—focus on the cancer cells, rather than attacking both the cancer cells and the healthy cells
• High-intensity focused ultrasound—an endorectal probe (a probe that is inserted into the rectum) is used to destroy cancer cells with ultrasound energy